=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003496118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIVE STAR AID, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2021
-----------------------------------------------------
Last Update Date | 05/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13400 RIVERSIDE DR STE 204
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-278-0109
-----------------------------------------------------
Fax | 818-748-6021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13400 RIVERSIDE DR STE 204
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-278-0109
-----------------------------------------------------
Fax | 818-748-6021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LEVON KHACHATRYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-278-0109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------