Provider Demographics
NPI:1699815530
Name:ST JACOB HOSPICE INC
Entity Type:Organization
Organization Name:ST JACOB HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANAHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHRIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:818-368-9995
Mailing Address - Street 1:17042 DEVONSHIRE ST
Mailing Address - Street 2:#209
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17042 DEVONSHIRE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1674
Practice Address - Country:US
Practice Address - Phone:818-368-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based