MEDICARE: PERENNIAL HOSPICE CARE LLC

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	:	1063014462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERENNIAL HOSPICE CARE LLC

Provider Business Mailing Address
First Line	:	2319 W OLIVE AVE STE B
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2627
Country	:	US
Telephone Number	:	747-282-1802
Fax Number	:	747-282-1803

Provider Business Practice Location Address
First Line	:	2319 W OLIVE AVE STE B
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2627
Country	:	US
Telephone Number	:	747-282-1802
Fax Number	:	747-282-1803

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK KALASHYAN
Credential	:
Telephone Number	:	747-282-1802

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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