Provider Demographics
NPI:1972808426
Name:GREAT AMERICAN HOSPICE, INC.
Entity type:Organization
Organization Name:GREAT AMERICAN HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAYANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-725-1575
Mailing Address - Street 1:5454 HERMITAGE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2062
Mailing Address - Country:US
Mailing Address - Phone:818-725-1575
Mailing Address - Fax:
Practice Address - Street 1:5454 HERMITAGE AVE APT 1
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2062
Practice Address - Country:US
Practice Address - Phone:818-725-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based