Provider Demographics
NPI:1598309163
Name:ST. LILLY HOSPICE, INC.
Entity Type:Organization
Organization Name:ST. LILLY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUTYUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-862-4044
Mailing Address - Street 1:14126 SHERMAN WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-5633
Mailing Address - Country:US
Mailing Address - Phone:818-862-4044
Mailing Address - Fax:818-862-4045
Practice Address - Street 1:14126 SHERMAN WAY STE 209
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-5600
Practice Address - Country:US
Practice Address - Phone:818-862-4044
Practice Address - Fax:818-862-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based