=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306437116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA SPECIAL CARE HOSPICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2021
-----------------------------------------------------
Last Update Date | 02/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5106 HOLLYWOOD BLVD STE 103
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-928-2001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5106 HOLLYWOOD BLVD STE 103
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-928-2001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DAVIT SIMONYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-928-2001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------