Provider Demographics
NPI:1205417458
Name:CLOVER CARE HOSPICE INC
Entity Type:Organization
Organization Name:CLOVER CARE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRAPETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-296-5625
Mailing Address - Street 1:18531 ROSCOE BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18531 ROSCOE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5450
Practice Address - Country:US
Practice Address - Phone:818-296-5625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based