Provider Demographics
NPI:1174107395
Name:PREMIER HOSPICE OF LA, INC.
Entity type:Organization
Organization Name:PREMIER HOSPICE OF LA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-533-1144
Mailing Address - Street 1:4100 W ALAMEDA AVE STE 379
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4153
Mailing Address - Country:US
Mailing Address - Phone:818-533-1144
Mailing Address - Fax:818-369-3329
Practice Address - Street 1:4100 W ALAMEDA AVE STE 379
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4153
Practice Address - Country:US
Practice Address - Phone:818-533-1144
Practice Address - Fax:818-369-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based