Provider Demographics
NPI:1528674777
Name:OPTIMUM HOSPICE INC
Entity type:Organization
Organization Name:OPTIMUM HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMATHKHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-666-3194
Mailing Address - Street 1:7311 VAN NUYS BLVD
Mailing Address - Street 2:UNIT 7
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1958
Mailing Address - Country:US
Mailing Address - Phone:818-459-4950
Mailing Address - Fax:
Practice Address - Street 1:7311 VAN NUYS BLVD
Practice Address - Street 2:UNIT 7
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1958
Practice Address - Country:US
Practice Address - Phone:818-459-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based