MEDICARE: HEALTHY LIFE HOSPICE INC

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		CA

General Provider Information

NPI Number	:	1164859112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIFE HOSPICE INC

Provider Business Mailing Address
First Line	:	12509 OXNARD ST
Second Line	:	SUITE 215
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4467
Country	:	US
Telephone Number	:	818-308-6255
Fax Number	:	818-358-2069

Provider Business Practice Location Address
First Line	:	12509 OXNARD ST
Second Line	:	SUITE 215
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4467
Country	:	US
Telephone Number	:	818-308-6255
Fax Number	:	818-358-2069

Authorized Official
Title or Position	:	CEO
Name	:	MR. POGOS CHADRCHYAN
Credential	:
Telephone Number	:	818-308-6255

Provider Enumeration Date	:	10/07/2013
Last Update Date	:	09/03/2015

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