MEDICARE: PROVIDER LINK HOSPICE AND PALLIATIVE CARE 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	:	1548860521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDER LINK HOSPICE AND PALLIATIVE CARE INC

Provider Business Mailing Address
First Line	:	10999 RIVERSIDE DR STE 210
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2239
Country	:	US
Telephone Number	:	818-452-9529
Fax Number	:

Provider Business Practice Location Address
First Line	:	10999 RIVERSIDE DR STE 210
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2239
Country	:	US
Telephone Number	:	818-452-9529
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDITA HOVHANNISYAN
Credential	:
Telephone Number	:	818-452-9529

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2022

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