Provider Demographics
NPI:1275146144
Name:LAVELLA HOSPICE, INC.
Entity Type:Organization
Organization Name:LAVELLA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMIKONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-482-0577
Mailing Address - Street 1:5900 SEPULVEDA BLVD # 102-6
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2511
Mailing Address - Country:US
Mailing Address - Phone:818-482-0577
Mailing Address - Fax:818-301-0330
Practice Address - Street 1:5900 SEPULVEDA BLVD # 102-6
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2511
Practice Address - Country:US
Practice Address - Phone:424-339-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based