=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184261240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELDON HOSPICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2019
-----------------------------------------------------
Last Update Date | 02/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19531 VENTURA BLVD # 10
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-2957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-814-8040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19531 VENTURA BLVD # 10
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-2957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DIANA KOSTIKIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-814-8040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------