=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063014462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERENNIAL HOSPICE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2020
-----------------------------------------------------
Last Update Date | 11/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2319 W OLIVE AVE STE B
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-282-1802
-----------------------------------------------------
Fax | 747-282-1803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2319 W OLIVE AVE STE B
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-282-1802
-----------------------------------------------------
Fax | 747-282-1803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PATRICK KALASHYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-282-1802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------