Provider Demographics
NPI:1316595283
Name:LA HOSPICE CENTER, INC.
Entity Type:Organization
Organization Name:LA HOSPICE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:
Authorized Official - Last Name:JABAGURYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-714-8769
Mailing Address - Street 1:13609 VICTORY BLVD UNIT 209
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1736
Mailing Address - Country:US
Mailing Address - Phone:877-714-8769
Mailing Address - Fax:
Practice Address - Street 1:13609 VICTORY BLVD UNIT 209
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1736
Practice Address - Country:US
Practice Address - Phone:877-714-8769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid