Provider Demographics
NPI:1356947899
Name:AVITA HOSPICE CARE INC
Entity type:Organization
Organization Name:AVITA HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBEDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-245-4417
Mailing Address - Street 1:613 E GLENOAKS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1711
Mailing Address - Country:US
Mailing Address - Phone:818-245-4417
Mailing Address - Fax:818-688-8164
Practice Address - Street 1:613 E GLENOAKS BLVD STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1711
Practice Address - Country:US
Practice Address - Phone:818-245-4417
Practice Address - Fax:818-688-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based