Provider Demographics
NPI:1588158893
Name:LIFE HOSPICE, INC.
Entity type:Organization
Organization Name:LIFE HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-202-8430
Mailing Address - Street 1:11033 COHASSET ST
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4702
Mailing Address - Country:US
Mailing Address - Phone:747-202-8430
Mailing Address - Fax:714-333-4447
Practice Address - Street 1:5101 E LA PALMA AVE STE 100P
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2056
Practice Address - Country:US
Practice Address - Phone:714-464-2018
Practice Address - Fax:714-333-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid