Provider Demographics
NPI:1083999205
Name:MED STAR HOSPICE CARE INC
Entity Type:Organization
Organization Name:MED STAR HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-359-3415
Mailing Address - Street 1:1801 S. MYRTLE ST SUITE F
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016
Mailing Address - Country:US
Mailing Address - Phone:626-359-3415
Mailing Address - Fax:
Practice Address - Street 1:1801 S. MYRTLE ST SUITE F
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016
Practice Address - Country:US
Practice Address - Phone:626-359-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health