=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285995308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MKA HOSPICE CARE., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2012
-----------------------------------------------------
Last Update Date | 10/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17607 SHERMAN WAY SUITE 204
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-1760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-746-2826
-----------------------------------------------------
Fax | 818-353-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17607 SHERMAN WAY SUITE 204
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-1760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-746-2826
-----------------------------------------------------
Fax | 818-353-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEOPRESIDENT
-----------------------------------------------------
Name | POGOS MARTINYAN
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 818-746-2826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------