MEDICARE: MID VALLEY 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	:	1235445248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID VALLEY HOSPICE, INC.

Provider Business Mailing Address
First Line	:	4737 LANKERSHIM BLVD
Second Line	:	SUITE 206
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1803
Country	:	US
Telephone Number	:	818-506-1700
Fax Number	:	818-506-1717

Provider Business Practice Location Address
First Line	:	4737 LANKERSHIM BLVD
Second Line	:	SUITE 206
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1803
Country	:	US
Telephone Number	:	818-506-1700
Fax Number	:	818-506-1717

Authorized Official
Title or Position	:	CEO
Name	:	ANAHID SAFARIAN
Credential	:
Telephone Number	:	818-506-1700

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	08/27/2010

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