MEDICARE: PRIMARY CARE 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	:	1891089371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE HOSPICE INC.

Provider Business Mailing Address
First Line	:	13609 VICTORY BLVD
Second Line	:	STE. 221
City	:	VAN NUYS
State	:	CA
Zip	:	91401-9998
Country	:	US
Telephone Number	:	818-963-5556
Fax Number	:	818-450-1470

Provider Business Practice Location Address
First Line	:	13609 VICTORY BLVD
Second Line	:	STE. 221
City	:	VAN NUYS
State	:	CA
Zip	:	91401-9998
Country	:	US
Telephone Number	:	818-963-5556
Fax Number	:	818-450-1470

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARAM AVAKYAN
Credential	:
Telephone Number	:	818-963-5556

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	06/02/2011

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