MEDICARE: PRIMARY HEALTHCARE SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1003438839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HEALTHCARE SOLUTIONS

Provider Business Mailing Address
First Line	:	11436 VANOWEN ST STE A
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6220
Country	:	US
Telephone Number	:	310-666-2392
Fax Number	:	818-484-2919

Provider Business Practice Location Address
First Line	:	11436 VANOWEN ST STE A
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6220
Country	:	US
Telephone Number	:	310-666-2392
Fax Number	:	818-484-2919

Authorized Official
Title or Position	:	CEO/CFO/SECRETARY
Name	:	DAVIT HAKOBYAN
Credential	:
Telephone Number	:	310-666-2392

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	09/30/2021

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