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General NPI Number Information
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NPI Number | 1700452075
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Entity Type | Organization
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Legal Business Name | IMMENSE HOSPICE, INC
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 2000 W MAGNOLIA BLVD STE 202
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City | BURBANK
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State | CA
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Zip | 91506-1744
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Country | US
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Telephone | 747-895-5114
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Fax | 747-895-5116
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Provider Business Mailing Address
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Address Line | 2000 W MAGNOLIA BLVD STE 202
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City | BURBANK
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State | CA
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Zip | 91506-1744
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Country | US
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Telephone | 747-895-5114
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Fax | 747-895-5116
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Authorized Official
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Title or Position | CEO
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Name | HOVANES JERAGYAN
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Credential |
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Telephone | 747-895-5114
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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 |
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License Number State |
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