=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649603747
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAYER OF HOPE HOSPICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2013
-----------------------------------------------------
Last Update Date | 10/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12045 RIVERSIDE DR
-----------------------------------------------------
City | VALLEY VILAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-732-8073
-----------------------------------------------------
Fax | 818-579-7733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12045 RIVERSIDE DR
-----------------------------------------------------
City | VALLEY VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91607-3744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-732-8073
-----------------------------------------------------
Fax | 818-579-7733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ARTEM MOISEEKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-732-8073
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------