Healthcare Provider Details

I. General information

NPI: 1467048629
Provider Name (Legal Business Name): HEAVENLY HOSPICE CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W BROADWAY STE 305
GLENDALE CA
91204-1297
US

IV. Provider business mailing address

412 W BROADWAY STE 305
GLENDALE CA
91204-1297
US

V. Phone/Fax

Practice location:
  • Phone: 818-945-0002
  • Fax: 818-945-0004
Mailing address:
  • Phone: 818-945-0002
  • Fax: 818-945-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANAHIT SARGSYAN
Title or Position: CEO
Credential:
Phone: 818-945-0002