=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023358330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT MONTSERRAT HOSPICE CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2013
-----------------------------------------------------
Last Update Date | 03/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 523 N GLENOAKS BLVD
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-567-6520
-----------------------------------------------------
Fax | 818-567-6522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 523 N GLENOAKS BLVD
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-567-6520
-----------------------------------------------------
Fax | 818-567-6522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. GOR NAKHIKYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-567-6520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------