MEDICARE: HOLISTIC 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	550002348	CA

General Provider Information

NPI Number	:	1659631109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HOSPICE, INC.

Provider Business Mailing Address
First Line	:	9608 VAN NUYS BLVD STE 203
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-830-6900
Fax Number	:	818-830-8900

Provider Business Practice Location Address
First Line	:	9608 VAN NUYS BLVD STE 203
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-830-6900
Fax Number	:	818-830-8900

Authorized Official
Title or Position	:	CEO
Name	:	ARMINE POGHOSYAN
Credential	:
Telephone Number	:	818-830-6900

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	05/05/2015

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