=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689298325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PNH HOSPICE GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2020
-----------------------------------------------------
Last Update Date | 09/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16909 PARTHENIA ST STE 301A
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-666-2392
-----------------------------------------------------
Fax | 818-484-2919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16909 PARTHENIA ST STE 301A
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-4551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-666-2392
-----------------------------------------------------
Fax | 818-484-2919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CFO/SECRETARY
-----------------------------------------------------
Name | DAVIT HAKOBYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-666-2392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------