Mountainside Hospice and Palliative Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

MOUNTAINSIDE HOSPICE AND PALLIATIVE CARE INC

Practice address

8700 Reseda Blvd Ste 103
Northridge, CA 91324-5384

Phone

(818) 818-5009

NPI assigned

Apr 17, 2020

Organization subpart

No

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

Authorized official

Name

Edward Otuzbiryan

Title

Ceo

Phone

(818) 818-5009

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B21626

Legal name

MOUNTAINSIDE HOSPICE AND PALLIATIVE CARE, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 14, 2021

Last certification

May 14, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 13, 2020 in CA

Enrollment address

20955 Devonshire St
Ste a
Chatsworth, CA 91311-2313

Listed as

Mountainside Hospice and Palliative Care, Inc.CCN B21626

Ownership

For-Profit

Certified

May 14, 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 2

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

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587081600000",
    "number": "1336769512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8700 RESEDA BLVD STE 103",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 RESEDA BLVD STE 103",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913245384",
            "telephone_number": "818-818-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSIDE HOSPICE AND PALLIATIVE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A",
        "authorized_official_last_name": "OTUZBIRYAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-818-5009"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.