Life Source Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LIFE SOURCE HOSPICE INC

Practice address

232 N Lake Ave Ste 216
Pasadena, CA 91101-1862

Phone

(626) 263-2323

NPI assigned

Jan 31, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yervan Mnatsakanyan

Title

Ceo

Phone

(626) 263-2323

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN A11646

Legal name

LIFE SOURCE HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 15, 2020

Last certification

Oct 15, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Apr 30, 2019 in CA

Enrollment address

6819 Sepulveda Blvd
Ste 209
Van Nuys, CA 91405-4440

Listed as

Life Source HospiceCCN A11646

Ownership

For-Profit

Certified

Oct 15, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• John Spillane Burns, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1407921737

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• John Spillane Burns, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1407921737

  Hospice

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1033740758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 N LAKE AVE STE 216",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911011862",
            "telephone_number": "626-263-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 N LAKE AVE STE 216",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911011862",
            "telephone_number": "626-263-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-31",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "MNATSAKANYAN",
        "authorized_official_first_name": "YERVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-263-2323"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Uyen Lien, OD
• Heather Lien
• Peter J Liepmann, MD
• Terry W Liepmann, MS LMFT
• Life Fitness Center a Medical Group Inc
• Lifecare Solutions Inc
• Lifecare Solutions Inc
• Lifecare Solutions Inc
• Lifeline Hospice Care, Inc
• Lifovum Fertility Managment, LLC

• Community Based Hospice Care Agency in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.