Provider Demographics
NPI:1821365982
Name:MID CITY HOSPICE, INC.
Entity Type:Organization
Organization Name:MID CITY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SMBAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-988-8655
Mailing Address - Street 1:7136 HASKELL AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4112
Mailing Address - Country:US
Mailing Address - Phone:818-988-8655
Mailing Address - Fax:818-988-8502
Practice Address - Street 1:7136 HASKELL AVE
Practice Address - Street 2:STE 107
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:818-988-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based