Provider Demographics
NPI:1992295075
Name:ST. MARY'S HOSPICE AND PALLIATIVE CARE, INC.
Entity type:Organization
Organization Name:ST. MARY'S HOSPICE AND PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRKHANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-497-7474
Mailing Address - Street 1:14545 FRIAR ST STE 217
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2399
Mailing Address - Country:US
Mailing Address - Phone:818-497-7474
Mailing Address - Fax:
Practice Address - Street 1:14545 FRIAR ST STE 217
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2399
Practice Address - Country:US
Practice Address - Phone:818-497-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based