Provider Demographics
NPI:1508165069
Name:HOSPICE OF ST. GEORGE, INC.
Entity Type:Organization
Organization Name:HOSPICE OF ST. GEORGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANJYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-553-8000
Mailing Address - Street 1:415 E HARVARD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1057
Mailing Address - Country:US
Mailing Address - Phone:818-553-8000
Mailing Address - Fax:818-553-8118
Practice Address - Street 1:415 E HARVARD ST
Practice Address - Street 2:STE 101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1057
Practice Address - Country:US
Practice Address - Phone:818-553-8000
Practice Address - Fax:818-553-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based