MEDICARE: SAFEWAY HOSPICE CORP

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1487040846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY HOSPICE CORP

Provider Business Mailing Address
First Line	:	415 E HARVARD ST
Second Line	:	SUITE 203
City	:	GLENDALE
State	:	CA
Zip	:	91205-1057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 E HARVARD ST
Second Line	:	SUITE 203
City	:	GLENDALE
State	:	CA
Zip	:	91205-1057
Country	:	US
Telephone Number	:	818-852-4738
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	HANRIETTA SARGSYAN
Credential	:
Telephone Number	:	818-852-4738

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/13/2015

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Directions to “SAFEWAY HOSPICE CORP ” Practice Location

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