MEDICARE: MAPLE GLEN 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	:	1417538810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE GLEN HOSPICE INC

Provider Business Mailing Address
First Line	:	3306 W BURBANK BLVD STE D
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2230
Country	:	US
Telephone Number	:	747-253-0513
Fax Number	:

Provider Business Practice Location Address
First Line	:	3306 W BURBANK BLVD STE D
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2230
Country	:	US
Telephone Number	:	747-253-0513
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANIEL SHALVARDZHYAN
Credential	:
Telephone Number	:	747-253-0513

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	04/16/2021

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