MEDICARE: GRACIOUS CARE 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

General Provider Information

NPI Number	:	1205429388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACIOUS CARE HOSPICE INC

Provider Business Mailing Address
First Line	:	7580 SAN FERNANDO RD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4346
Country	:	US
Telephone Number	:	747-268-2928
Fax Number	:

Provider Business Practice Location Address
First Line	:	7580 SAN FERNANDO RD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4346
Country	:	US
Telephone Number	:	747-268-2928
Fax Number	:	818-256-3333

Authorized Official
Title or Position	:	CEO/DIRECTOR
Name	:	MARY MKRTCHYAN
Credential	:
Telephone Number	:	747-268-2928

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	02/18/2021

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