MGD Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

MGD HOSPICE, INC.

Practice address

18570 Sherman Way Ste E
Reseda, CA 91335-8635

Phone

(818) 578-3696

NPI assigned

Jun 24, 2020

Organization subpart

No

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

Authorized official

Name

Madelna Davtyan

Title

Ceo

Phone

(818) 578-3696

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN A11647

Legal name

MGD HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 7, 2020

Last certification

Oct 7, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Aug 19, 2019 in CA

Enrollment address

18623 Ventura Blvd
Ste 204
Tarzana, CA 91356-4140

Listed as

MGD Hospice, IncCCN A11647

Ownership

For-Profit

Certified

Oct 7, 2020

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.

• Gary Austin Grimes, MD

  • Family Medicine Physician
  • Palmdale, CA
  • NPI 1922172089

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1285250381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18570 SHERMAN WAY STE E",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913358635",
            "telephone_number": "818-578-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18570 SHERMAN WAY STE E",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913358635",
            "telephone_number": "818-578-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGD HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-24",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "DAVTYAN",
        "authorized_official_first_name": "MADELNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-578-3696"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benito Mendoza
• Justin Mendoza, PA
• Manuel A Mendoza
• Alexa Marie Metrano
• Solomon Onyekachukwu Mezinwa, MD
• Michael Homayun Dental Corporation
• Michael Rabizadeh, D.D.S., P.C.
• Clarissa Michael, PCD(DONA)
• Hunter Michael
• Mid Valley Vascular Center, Inc

• Community Based Hospice Care Agency in Reseda, CA
• Providers in Reseda, 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 Jun 24, 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.