MEDICARE: PROSPEROUS HOSPICE CARE 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	:	1407437833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPEROUS HOSPICE CARE INC

Provider Business Mailing Address
First Line	:	8345 RESEDA BLVD STE 222
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-5933
Country	:	US
Telephone Number	:	818-282-8344
Fax Number	:

Provider Business Practice Location Address
First Line	:	8345 RESEDA BLVD STE 222
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-5933
Country	:	US
Telephone Number	:	818-282-8344
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ASHOT HAYRAPETYAN
Credential	:
Telephone Number	:	818-282-8344

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	04/17/2021

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