Provider Demographics
NPI:1558599308
Name:HEAVENLY HOSPICE INC.
Entity Type:Organization
Organization Name:HEAVENLY HOSPICE INC.
Other - Org Name:HEAVENLY HOSPICE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KYABABCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-442-4999
Mailing Address - Street 1:2500 WILSHIRE BLVD #818
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-386-3067
Mailing Address - Fax:213-386-5803
Practice Address - Street 1:2500 WILSHIRE BLVD #818
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-386-3067
Practice Address - Fax:213-386-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002448272-0001-4251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based