Provider Demographics
NPI:1083099931
Name:ANGELS LIGHT HOSPICE
Entity type:Organization
Organization Name:ANGELS LIGHT HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KHACHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-249-9933
Mailing Address - Street 1:4250 PENNSYLVANIA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3369
Mailing Address - Country:US
Mailing Address - Phone:818-249-9933
Mailing Address - Fax:818-249-9005
Practice Address - Street 1:4250 PENNSYLVANIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3369
Practice Address - Country:US
Practice Address - Phone:818-249-9933
Practice Address - Fax:818-249-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based