MEDICARE: VERONA HOSPICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP1600X	Pastoral Counselor
2	1041C0700X	Clinical Social Worker
3	163WC0400X	Case Management Registered Nurse
4	251J00000X	Nursing Care Agency
5	385H00000X	Respite Care
6	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1811547383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERONA HOSPICE, INC.

Provider Business Mailing Address
First Line	:	9608 VAN NUYS BLVD STE 204A
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-830-8883
Fax Number	:	818-830-8884

Provider Business Practice Location Address
First Line	:	9608 VAN NUYS BLVD STE 204A
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-830-8883
Fax Number	:	818-830-8884

Authorized Official
Title or Position	:	CEO
Name	:	MR. IVAN GORSKIKH
Credential	:
Telephone Number	:	818-830-8883

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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Directions to “VERONA HOSPICE, INC. ” Practice Location

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