=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780291435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA CRESCENTA HOSPICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2020
-----------------------------------------------------
Last Update Date | 09/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2233 HONOLULU AVE UNIT 206
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91020-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-451-3278
-----------------------------------------------------
Fax | 213-451-3278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2233 HONOLULU AVE UNIT 206
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91020-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-451-3278
-----------------------------------------------------
Fax | 213-451-3278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | EVA BIYAZYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-745-8097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------