Provider Demographics
NPI:1740849538
Name:AVME HOSPICE CARE
Entity type:Organization
Organization Name:AVME HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENESYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-267-7177
Mailing Address - Street 1:18747 SHERMAN WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4000
Mailing Address - Country:US
Mailing Address - Phone:747-267-7177
Mailing Address - Fax:
Practice Address - Street 1:18747 SHERMAN WAY STE 106
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4000
Practice Address - Country:US
Practice Address - Phone:747-267-7177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid