Provider Demographics
NPI:1780285395
Name:BABY BOOMERS HOSPICE CARE INC
Entity type:Organization
Organization Name:BABY BOOMERS HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-354-5554
Mailing Address - Street 1:17817 CHATSWORTH ST UNIT 220
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5612
Mailing Address - Country:US
Mailing Address - Phone:877-354-5554
Mailing Address - Fax:
Practice Address - Street 1:17817 CHATSWORTH ST UNIT 220
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5612
Practice Address - Country:US
Practice Address - Phone:877-354-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based