Provider Demographics
NPI:1285218495
Name:PRINCIPLE HOSPICE, INC.
Entity Type:Organization
Organization Name:PRINCIPLE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSKIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-836-9388
Mailing Address - Street 1:9608 VAN NUYS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1043
Mailing Address - Country:US
Mailing Address - Phone:818-836-9388
Mailing Address - Fax:
Practice Address - Street 1:9608 VAN NUYS BLVD STE 208
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1043
Practice Address - Country:US
Practice Address - Phone:818-836-9388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based