MEDICARE: RESTFUL RETREAT, 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	:	1528648524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTFUL RETREAT, INC

Provider Business Mailing Address
First Line	:	6410 VAN NUYS BLVD UNIT F204
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-6263
Country	:	US
Telephone Number	:	626-313-3535
Fax Number	:	626-313-3533

Provider Business Practice Location Address
First Line	:	6410 VAN NUYS BLVD UNIT F204
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-6263
Country	:	US
Telephone Number	:	626-313-3535
Fax Number	:	626-313-3533

Authorized Official
Title or Position	:	CEO
Name	:	ELIZABETH KNADJIAN
Credential	:
Telephone Number	:	626-313-3535

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	04/13/2021

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Directions to “RESTFUL RETREAT, INC ” Practice Location

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