MEDICARE: ST VINCENT HOSPICE SERVICES, 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	:	1447666995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST VINCENT HOSPICE SERVICES, INC

Provider Business Mailing Address
First Line	:	420 S ROSEMEAD BLVD
Second Line	:	SUITE D-E
City	:	PASADENA
State	:	CA
Zip	:	91107-4980
Country	:	US
Telephone Number	:	626-796-1922
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 S ROSEMEAD BLVD
Second Line	:	SUITE D-E
City	:	PASADENA
State	:	CA
Zip	:	91107-4980
Country	:	US
Telephone Number	:	626-796-1922
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VADIM DANIELIAN
Credential	:
Telephone Number	:	323-821-7772

Provider Enumeration Date	:	07/05/2014
Last Update Date	:	07/05/2014

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