Provider Demographics
NPI:1285208843
Name:MOUNTAIN RIDGE HOSPICE INC.
Entity Type:Organization
Organization Name:MOUNTAIN RIDGE HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HRIPSIME
Authorized Official - Middle Name:
Authorized Official - Last Name:KNYAZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-934-7424
Mailing Address - Street 1:225 E BROADWAY # B114A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1008
Mailing Address - Country:US
Mailing Address - Phone:818-934-7424
Mailing Address - Fax:818-937-9040
Practice Address - Street 1:225 E BROADWAY # B114A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1008
Practice Address - Country:US
Practice Address - Phone:818-934-7424
Practice Address - Fax:818-937-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based