Provider Demographics
NPI:1811166069
Name:ACE OF HEARTS HOSPICE INC.
Entity type:Organization
Organization Name:ACE OF HEARTS HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:ROZANNA
Authorized Official - Middle Name:OF HEARTS
Authorized Official - Last Name:AVETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-875-4118
Mailing Address - Street 1:6501 FOOTHILL BLVD.
Mailing Address - Street 2:204A
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2768
Mailing Address - Country:US
Mailing Address - Phone:818-875-4118
Mailing Address - Fax:818-875-4119
Practice Address - Street 1:6501 FOOTHILL BLVD.
Practice Address - Street 2:204A
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2768
Practice Address - Country:US
Practice Address - Phone:818-875-4118
Practice Address - Fax:818-875-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551598Medicare Oscar/Certification