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General NPI Number Information
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NPI Number | 1558599308
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Entity Type | Organization
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Legal Business Name | HEAVENLY HOSPICE INC.
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 2500 WILSHIRE BLVD #818
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 213-386-3067
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Fax | 213-386-5803
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Provider Business Mailing Address
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Address Line | 2500 WILSHIRE BLVD #818
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City | LOS ANGELES
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State | CA
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Zip | 90057
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Country | US
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Telephone | 213-386-3067
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Fax | 213-386-5803
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Authorized Official
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Title or Position | CEO
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Name | ELIZA E KYABABCHYAN
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Credential |
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Telephone | 818-442-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 0002448272-0001-4
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License Number State | CA
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