MEDICARE: LOYAL HOSPICE CARE, 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	:	1912328485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOYAL HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	9608 VAN NUYS BLVD STE 207B
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-891-6777
Fax Number	:	818-891-9777

Provider Business Practice Location Address
First Line	:	9608 VAN NUYS BLVD STE 207B
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-891-6777
Fax Number	:	818-891-9777

Authorized Official
Title or Position	:	CEO
Name	:	EDUARD POGHOSYAN
Credential	:
Telephone Number	:	818-891-6777

Provider Enumeration Date	:	12/30/2013
Last Update Date	:	05/05/2015

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