Provider Demographics
NPI:1285915678
Name:LIFELINE HOSPICE, INC.
Entity type:Organization
Organization Name:LIFELINE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TATEVOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-988-7928
Mailing Address - Street 1:14349 VICTORY BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14349 VICTORY BLVD
Practice Address - Street 2:STE 204
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1950
Practice Address - Country:US
Practice Address - Phone:818-988-7928
Practice Address - Fax:818-474-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based