Provider Demographics
NPI:1134703788
Name:IDYLLIC HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:IDYLLIC HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHVERDYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-570-9863
Mailing Address - Street 1:2220 W BURBANK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1234
Mailing Address - Country:US
Mailing Address - Phone:800-570-9863
Mailing Address - Fax:
Practice Address - Street 1:2220 W BURBANK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1234
Practice Address - Country:US
Practice Address - Phone:800-570-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based