Provider Demographics
NPI:1033791215
Name:FAIRFAX HOSPICE INC
Entity Type:Organization
Organization Name:FAIRFAX HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-491-5075
Mailing Address - Street 1:1812 W BURBANK BLVD # 861
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1315
Mailing Address - Country:US
Mailing Address - Phone:818-491-5075
Mailing Address - Fax:818-964-1014
Practice Address - Street 1:7630 VINELAND AVE STE 207
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4535
Practice Address - Country:US
Practice Address - Phone:818-491-5075
Practice Address - Fax:818-964-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based