Provider Demographics
NPI:1588288849
Name:BLUE RIVER HOSPICE INC
Entity type:Organization
Organization Name:BLUE RIVER HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-921-3177
Mailing Address - Street 1:17620 SHERMAN WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3527
Mailing Address - Country:US
Mailing Address - Phone:818-254-8845
Mailing Address - Fax:
Practice Address - Street 1:171 N ALTADENA DR STE 235
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7319
Practice Address - Country:US
Practice Address - Phone:818-921-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-02
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based