Provider Demographics
NPI:1225524663
Name:VIRIDIAN HEALTHCARE LLC
Entity Type:Organization
Organization Name:VIRIDIAN HEALTHCARE LLC
Other - Org Name:VIRIDIAN HOSPICE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-877-5368
Mailing Address - Street 1:13658 HAWTHORNE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5822
Mailing Address - Country:US
Mailing Address - Phone:310-877-5368
Mailing Address - Fax:
Practice Address - Street 1:13658 HAWTHORNE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-877-5368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherIRS EIN