Provider Demographics
NPI:1962096784
Name:SHORELINE HOSPICE, INC.
Entity type:Organization
Organization Name:SHORELINE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHAJANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-261-6660
Mailing Address - Street 1:14402 HAYNES ST STE 207
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6245
Mailing Address - Country:US
Mailing Address - Phone:818-582-3208
Mailing Address - Fax:818-582-3218
Practice Address - Street 1:14402 HAYNES ST STE 207
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6245
Practice Address - Country:US
Practice Address - Phone:818-582-3208
Practice Address - Fax:818-582-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based