=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053980755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLACID HOSPICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2021
-----------------------------------------------------
Last Update Date | 06/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10545 BURBANK BLVD. SUITE 121
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91601-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-683-2223
-----------------------------------------------------
Fax | 818-301-2202
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10545 BURBANK BLVD. SUITE 121
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91601-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-683-2223
-----------------------------------------------------
Fax | 818-301-2202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. NAIRA GYANDZHYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-683-2223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------