=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285227835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIDZ HOSPICE CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2021
-----------------------------------------------------
Last Update Date | 02/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2930 HONOLULU AVE UNIT 202
-----------------------------------------------------
City | LA CRESCENTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91214-3978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-255-5043
-----------------------------------------------------
Fax | 747-255-4619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2930 HONOLULU AVE UNIT 202
-----------------------------------------------------
City | LA CRESCENTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91214-3978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-255-5043
-----------------------------------------------------
Fax | 747-255-4619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | SAMVEL STEPANYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-255-5043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------