MEDICARE: SAINT LUKA 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

General Provider Information

NPI Number	:	1720557333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT LUKA HOSPICE, INC.

Provider Business Mailing Address
First Line	:	517 E WILSON AVE STE 103B
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4376
Country	:	US
Telephone Number	:	818-960-7272
Fax Number	:	818-960-7277

Provider Business Practice Location Address
First Line	:	517 E WILSON AVE STE 103B
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4376
Country	:	US
Telephone Number	:	818-960-7272
Fax Number	:	818-960-7277

Authorized Official
Title or Position	:	CFO/SECRETARY
Name	:	MARINA ZILFYAN
Credential	:
Telephone Number	:	818-960-7272

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	11/13/2018

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