Provider Demographics
NPI:1942560578
Name:MT SINAI HOSPICE INC
Entity Type:Organization
Organization Name:MT SINAI HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUSINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YARALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-394-8668
Mailing Address - Street 1:13746 VICTORY BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6725
Mailing Address - Country:US
Mailing Address - Phone:888-394-0668
Mailing Address - Fax:
Practice Address - Street 1:13746 VICTORY BLVD STE 217
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6725
Practice Address - Country:US
Practice Address - Phone:888-394-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751726Medicaid
CA751726Medicaid