Provider Demographics
NPI:1861014417
Name:HOSPICE OF PROVIDENCE, INC
Entity Type:Organization
Organization Name:HOSPICE OF PROVIDENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GYULAKUBYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-855-1411
Mailing Address - Street 1:4533 VAN NUYS BLVD STE 301B
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2950
Mailing Address - Country:US
Mailing Address - Phone:818-855-1411
Mailing Address - Fax:
Practice Address - Street 1:4533 VAN NUYS BLVD STE 301B
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2950
Practice Address - Country:US
Practice Address - Phone:818-855-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based