Healthcare Provider Details

I. General information

NPI: 1225524663
Provider Name (Legal Business Name): VIRIDIAN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13658 HAWTHORNE BLVD STE 201
HAWTHORNE CA
90250
US

IV. Provider business mailing address

13658 HAWTHORNE BLVD STE 201
HAWTHORNE CA
90250-5822
US

V. Phone/Fax

Practice location:
  • Phone: 310-877-5368
  • Fax:
Mailing address:
  • Phone: 310-877-5368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HENRY PEKUN
Title or Position: PRESIDENT
Credential:
Phone: 310-877-5368