Provider Demographics
NPI:1225436967
Name:ANTELOPE VALLEY SUPPORTIVE CARE & HOSP
Entity Type:Organization
Organization Name:ANTELOPE VALLEY SUPPORTIVE CARE & HOSP
Other - Org Name:ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODABAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-247-8345
Mailing Address - Street 1:1505 W AVENUE J STE 303
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2845
Mailing Address - Country:US
Mailing Address - Phone:661-247-8345
Mailing Address - Fax:661-247-8346
Practice Address - Street 1:1505 W AVENUE J STE 303
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2845
Practice Address - Country:US
Practice Address - Phone:661-247-8345
Practice Address - Fax:661-247-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based