Country Club Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

COUNTRY CLUB HOSPICE, INC.

Practice address

3089 N Lima St Ste D
Burbank, CA 91504-2013

Phone

(747) 200-4175

Fax

(747) 273-0558

NPI assigned

Sep 22, 2020

Organization subpart

No

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

Authorized official

Name

Mr. David Gabrielyan

Title

Ceo

Phone

(747) 200-4175

Specialties & licenses 1

Addresses

Listed as

Country Club Hospice, IncCCN B21787

Ownership

For-Profit

Certified

Nov 16, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1215543434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3089 N LIMA ST STE D",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915042013",
            "telephone_number": "747-200-4175",
            "fax_number": "747-273-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3089 N LIMA ST STE D",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915042013",
            "telephone_number": "747-200-4175",
            "fax_number": "747-273-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-22",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "GABRIELYAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "747-200-4175",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Burbank, CA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.