Provider Demographics
NPI:1427325802
Name:PRO HOSPICE AGENCY, INC
Entity type:Organization
Organization Name:PRO HOSPICE AGENCY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RIPSIME
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-435-9991
Mailing Address - Street 1:1665 W SHAW AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3508
Mailing Address - Country:US
Mailing Address - Phone:559-435-9991
Mailing Address - Fax:
Practice Address - Street 1:1665 W SHAW AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3508
Practice Address - Country:US
Practice Address - Phone:559-435-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002572315D00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002572OtherSTATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH