Healthcare Provider Details

I. General information

NPI: 1477132900
Provider Name (Legal Business Name): MIX CARE LA HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14242 VENTURA BLVD STE 211
SHERMAN OAKS CA
91423-2757
US

IV. Provider business mailing address

14242 VENTURA BLVD STE 211
SHERMAN OAKS CA
91423-2757
US

V. Phone/Fax

Practice location:
  • Phone: 323-443-6633
  • Fax:
Mailing address:
  • Phone: 323-443-6633
  • Fax:

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: ALEK TOROSYAN
Title or Position: OWNER
Credential:
Phone: 323-443-6633