Provider Demographics
NPI:1932399409
Name:AMIDA HOSPICE CARE INC
Entity Type:Organization
Organization Name:AMIDA HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SARGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-424-9159
Mailing Address - Street 1:18302 SIERRA HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3092
Mailing Address - Country:US
Mailing Address - Phone:661-424-9159
Mailing Address - Fax:661-424-9672
Practice Address - Street 1:18302 SIERRA HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3092
Practice Address - Country:US
Practice Address - Phone:661-424-9159
Practice Address - Fax:661-424-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001043251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551575Medicare Oscar/Certification