MEDICARE: SUBLIME HOSPICE

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	:	1922626274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBLIME HOSPICE

Provider Business Mailing Address
First Line	:	8925 SEPULVEDA BLVD STE 204B
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-4354
Country	:	US
Telephone Number	:	747-214-4428
Fax Number	:

Provider Business Practice Location Address
First Line	:	8925 SEPULVEDA BLVD STE 204B
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-4354
Country	:	US
Telephone Number	:	747-214-4428
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ASHOT DAVTYAN
Credential	:
Telephone Number	:	747-214-4428

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	07/13/2020

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Directions to “SUBLIME HOSPICE ” Practice Location

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