Provider Demographics
NPI:1740878487
Name:AMETHYST HOSPICE CARE INC.
Entity type:Organization
Organization Name:AMETHYST HOSPICE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/DPCS
Authorized Official - Prefix:
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDURASHIDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-294-6298
Mailing Address - Street 1:2139 TAPO ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3476
Mailing Address - Country:US
Mailing Address - Phone:805-261-0139
Mailing Address - Fax:805-261-0227
Practice Address - Street 1:2139 TAPO ST STE 207
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3476
Practice Address - Country:US
Practice Address - Phone:805-261-0139
Practice Address - Fax:805-261-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHOSPICEMedicaid