Green Way Hospice, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

GREEN WAY HOSPICE, INC.

Practice address

7630 Vineland Ave Ste 210a
Sun Valley, CA 91352-4535

Phone

(818) 660-9109

Fax

(714) 495-4082

NPI assigned

Jul 6, 2020

Organization subpart

No

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

Authorized official

Name

Lusine Revazyan

Title

Ceo/Owner

Phone

(818) 660-9109

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B31630

Legal name

GREEN WAY HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 12, 2021

Last certification

Dec 12, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

May 26, 2020 in CA

Enrollment address

7630 Vineland Ave
Ste 210a
Sun Valley, CA 91352-4535

Listed as

Green Way Hospice, IncCCN B31630

Certified

Dec 12, 2021

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

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

Affiliated clinicians 1

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

• Rodolfo Baguinguito Protacio, M.D.

  • Internal Medicine Physician
  • Glendale, CA
  • NPI 1154320836

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593993600000",
    "number": "1134747223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7630 VINELAND AVE STE 210A",
            "city": "SUN VALLEY",
            "state": "CA",
            "postal_code": "913524535",
            "telephone_number": "818-660-9109",
            "fax_number": "714-495-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7630 VINELAND AVE STE 210A",
            "city": "SUN VALLEY",
            "state": "CA",
            "postal_code": "913524535",
            "telephone_number": "818-660-9109",
            "fax_number": "714-495-4082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN WAY HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-06",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A",
        "authorized_official_last_name": "REVAZYAN",
        "authorized_official_first_name": "LUSINE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "818-660-9109"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Ann Goodman, LVN
• Goodway Transportation Inc
• Gracious Care Hospice Inc
• America Gramajo, LVN
• Emily Gray
• Fredrick Grigorian, DENTIST
• Yan Grigoryan
• Roberto Pablo Guerrero, MD
• Guiding Light Hospice, Inc.
• Maryna Gukova, RN

• Home Health Agency in Sun Valley, CA
• Providers in Sun Valley, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.