MEDICARE: FIVE STAR HOME 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	NON YET	CA

General Provider Information

NPI Number	:	1730206038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR HOME HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1028 N LAKE AVE STE 106
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-4570
Country	:	US
Telephone Number	:	626-791-1764
Fax Number	:	626-791-5362

Provider Business Practice Location Address
First Line	:	1028 N LAKE AVE STE 106
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-4570
Country	:	US
Telephone Number	:	626-791-1764
Fax Number	:	626-791-5362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EBRUY K ARABYAN
Credential	:
Telephone Number	:	626-791-1764

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	04/30/2013

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