Provider Demographics
NPI:1891360772
Name:BLUE BIRD HOSPICE
Entity Type:Organization
Organization Name:BLUE BIRD HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPCS
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KSENDZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-849-4541
Mailing Address - Street 1:21700 GOLDEN TRIANGLE RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21700 GOLDEN TRIANGLE RD STE 104A
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2616
Practice Address - Country:US
Practice Address - Phone:310-849-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based