Provider Demographics
NPI:1215534557
Name:HOMESERVE HOSPICE INC
Entity Type:Organization
Organization Name:HOMESERVE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DASHTOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-631-3848
Mailing Address - Street 1:2777 PACIFIC AVE STE J
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2625
Mailing Address - Country:US
Mailing Address - Phone:562-317-8676
Mailing Address - Fax:562-317-8677
Practice Address - Street 1:2777 PACIFIC AVE STE J
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2625
Practice Address - Country:US
Practice Address - Phone:562-317-8676
Practice Address - Fax:562-317-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based