Provider Demographics
NPI:1457966582
Name:DIVINE HEALTH HOSPICE INC.
Entity Type:Organization
Organization Name:DIVINE HEALTH HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMINE
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:KHACHARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-536-7375
Mailing Address - Street 1:225 E BROADWAY STE 111AB
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1008
Mailing Address - Country:US
Mailing Address - Phone:818-536-7375
Mailing Address - Fax:
Practice Address - Street 1:225 E BROADWAY STE 111AB
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1008
Practice Address - Country:US
Practice Address - Phone:818-536-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VS HEALTHCARE GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based