Provider Demographics
NPI:1811567332
Name:ICONIC HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:ICONIC HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-212-4551
Mailing Address - Street 1:10012 COMMERCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2304
Mailing Address - Country:US
Mailing Address - Phone:747-212-4551
Mailing Address - Fax:747-212-4552
Practice Address - Street 1:10012 COMMERCE AVE STE B
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2304
Practice Address - Country:US
Practice Address - Phone:747-212-4551
Practice Address - Fax:747-212-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based