Provider Demographics
NPI:1770295800
Name:CRESTVIEW HOSPICE INC
Entity type:Organization
Organization Name:CRESTVIEW HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAGOB
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:KASSABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-810-4405
Mailing Address - Street 1:3597 E MONARCH SKY LANE
Mailing Address - Street 2:STE 240 OFFICE 223
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3597 E MONARCH SKY LANE
Practice Address - Street 2:STE 240 OFFICE 223
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-810-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based