Organization Active NPI

Citywide Hospice Care, Inc

  • Community Based Hospice Care Agency
  • Burbank, CA
National Provider Identifier
1205440369
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
CITYWIDE HOSPICE CARE, INC
Practice address
7590 N Glenoaks Blvd Ste 103
Burbank, CA 91504-1011
Phone
(818) 875-4014
NPI assigned
Sep 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Authorized official

Name
Tatyana Sklyar
Title
Ceo
Phone
(818) 875-4014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

7590 N Glenoaks Blvd Ste 103
Burbank, CA 91504-1011

Mailing address

7590 N Glenoaks Blvd Ste 103
Burbank, CA 91504-1011
Phone (818) 875-4014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210701002438 CA Part A Provider - Hospice 1850792532 Practice locations: Burbank, CA

Hospice certification: CCN B31640

Legal name
CITYWIDE HOSPICE CARE INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 7, 2021
Last certification
Dec 7, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Aug 13, 2019 in CA
Enrollment address
7590 N Glenoaks Blvd
Ste 103
Burbank, CA 91504-1011

Care Compare: Hospice

Medicare Care Compare
Listed as
Citywide Hospice Care, IncCCN B31640 · All quality measures
Certified
Dec 7, 2021
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

7590 N Glenoaks Blvd
Ste 103
Burbank, CA 91504
Phone (818) 875-4014

8055 Foothill Blvd
Ste B
Sunland, CA 91040
Phone (818) 875-4014

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Tetyana Ustynova Individual 5% Or Greater Direct Ownership InterestCeo Sep 17, 2022 50%
Corporate OfficerCeo Sep 17, 2022 50%
Corporate DirectorCeo Sep 17, 2022 50%
W-2 Managing EmployeeAd;Ceo Sep 17, 2022 50%
Dushyant Arun Viswanathan Individual W-2 Managing EmployeeMD; Apr 10, 2024
Sergiy Artemchuk Individual 5% Or Greater Direct Ownership InterestCfo Sep 17, 2022 50%
Corporate OfficerCfo Sep 17, 2022 50%
Corporate DirectorCfo Sep 17, 2022 50%
W-2 Managing EmployeeCfo Sep 17, 2022 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1599177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1205440369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7590 N GLENOAKS BLVD STE 103",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915041011",
            "telephone_number": "818-875-4014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7590 N GLENOAKS BLVD STE 103",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915041011",
            "telephone_number": "818-875-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITYWIDE HOSPICE CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-04",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "SKLYAR",
        "authorized_official_first_name": "TATYANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-875-4014"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.