Provider Demographics
NPI:1376207936
Name:LIFESPAN HOSPICE CARE LLC
Entity Type:Organization
Organization Name:LIFESPAN HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-756-0809
Mailing Address - Street 1:450 N BRAND BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2349
Mailing Address - Country:US
Mailing Address - Phone:310-756-0809
Mailing Address - Fax:310-756-0809
Practice Address - Street 1:450 N BRAND BLVD STE 600
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2349
Practice Address - Country:US
Practice Address - Phone:310-756-0809
Practice Address - Fax:310-756-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based