MEDICARE: LOS ROBLES 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		CA

General Provider Information

NPI Number	:	1497026959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ROBLES HOSPICE, INC.

Provider Business Mailing Address
First Line	:	2955 E HILLCREST DR
Second Line	:	120
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3176
Country	:	US
Telephone Number	:	805-397-0500
Fax Number	:	805-397-0501

Provider Business Practice Location Address
First Line	:	2955 E HILLCREST DR
Second Line	:	120
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3176
Country	:	US
Telephone Number	:	805-397-0500
Fax Number	:	805-397-0501

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. SRBUI CHERKEZYAN
Credential	:
Telephone Number	:	805-338-5306

Provider Enumeration Date	:	01/14/2012
Last Update Date	:	01/14/2012

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