Healthcare Provider Details

I. General information

NPI: 1366984445
Provider Name (Legal Business Name): ANGEL RAYS HOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10324 BALBOA BLVD SUITE 203B
GRANADA HILLS CA
91344-7349
US

IV. Provider business mailing address

10324 BALBOA BLVD SUITE 203B
GRANADA HILLS CA
91344-7349
US

V. Phone/Fax

Practice location:
  • Phone: 818-701-7853
  • Fax: 818-208-9718
Mailing address:
  • Phone: 818-701-7853
  • Fax: 818-208-9718

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: RATI BUKHRASHVILI
Title or Position: CEO
Credential:
Phone: 760-650-1786