Provider Demographics
NPI:1710569991
Name:G STATE HOSPICE, INC
Entity Type:Organization
Organization Name:G STATE HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VARDUI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-648-4456
Mailing Address - Street 1:7055 VINELAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-6414
Mailing Address - Country:US
Mailing Address - Phone:818-648-4456
Mailing Address - Fax:831-604-2025
Practice Address - Street 1:7055 VINELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-6414
Practice Address - Country:US
Practice Address - Phone:818-648-4456
Practice Address - Fax:831-604-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based