Provider Demographics
NPI:1750845590
Name:ST. RITA HOSPICE, INC.
Entity Type:Organization
Organization Name:ST. RITA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANJYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-696-2300
Mailing Address - Street 1:415 E HARVARD ST STE 104A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1045
Mailing Address - Country:US
Mailing Address - Phone:805-306-0440
Mailing Address - Fax:818-241-7900
Practice Address - Street 1:415 E HARVARD ST STE 104A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1045
Practice Address - Country:US
Practice Address - Phone:805-306-0440
Practice Address - Fax:818-241-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid