Provider Demographics
NPI:1285216978
Name:DIVINE CHOICE HOSPICE, INC.
Entity Type:Organization
Organization Name:DIVINE CHOICE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUSINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-293-9812
Mailing Address - Street 1:1248 S GLENDALE AVE STE U
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3273
Mailing Address - Country:US
Mailing Address - Phone:818-293-9812
Mailing Address - Fax:
Practice Address - Street 1:1248 S GLENDALE AVE STE U
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3273
Practice Address - Country:US
Practice Address - Phone:818-293-9812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based