Provider Demographics
NPI:1831485408
Name:EMMANUEL HOSPICE INC
Entity Type:Organization
Organization Name:EMMANUEL HOSPICE INC
Other - Org Name:HOLLYWOOD HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-763-2728
Mailing Address - Street 1:4640 LANKERSHIM BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1848
Mailing Address - Country:US
Mailing Address - Phone:818-763-2728
Mailing Address - Fax:888-453-0513
Practice Address - Street 1:4640 LANKERSHIM BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1848
Practice Address - Country:US
Practice Address - Phone:187-632-7288
Practice Address - Fax:888-453-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002563036-0001-3251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551787Medicare Oscar/Certification