Provider Demographics
NPI:1669047759
Name:COMMONWEALTH HOSPICE CARE INC
Entity type:Organization
Organization Name:COMMONWEALTH HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SERYOZHA
Authorized Official - Middle Name:SERGO
Authorized Official - Last Name:KHRAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-300-0824
Mailing Address - Street 1:6314 VAN NUYS BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2625
Mailing Address - Country:US
Mailing Address - Phone:747-300-0824
Mailing Address - Fax:747-300-0854
Practice Address - Street 1:6314 VAN NUYS BLVD STE 206
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2625
Practice Address - Country:US
Practice Address - Phone:747-300-0824
Practice Address - Fax:747-300-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based