Healthcare Provider Details

I. General information

NPI: 1265972186
Provider Name (Legal Business Name): MED GROUP HOSPICE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10523 BURBANK BLVD. SUITE 124
NORTH HOLLYWOOD CA
91601-2236
US

IV. Provider business mailing address

10523 BURBANK BLVD. SUITE 124
NORTH HOLLYWOOD CA
91601-2236
US

V. Phone/Fax

Practice location:
  • Phone: 818-358-3811
  • Fax: 818-358-3860
Mailing address:
  • Phone: 818-358-3811
  • Fax: 818-358-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MHER KHACHATRYAN JR.
Title or Position: CEO
Credential:
Phone: 818-358-3811