Revive Hospice Care Group, Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

REVIVE HOSPICE CARE GROUP, INC

Practice address

3430 Ocean View Blvd Ste F
Glendale, CA 91208-1566

Phone

(818) 909-3444

Fax

(818) 909-2322

NPI assigned

Nov 14, 2013

Organization subpart

No

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

Authorized official

Name

Alis Penesyan

Title

Ceo

Phone

(818) 909-3444

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN 751727

Legal name

REVIVE HOSPICE CARE GROUP, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 19, 2015

Last certification

Aug 4, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Apr 25, 2013 in CA

Enrollment address

3430 Ocean View Blvd
Ste F
Glendale, CA 91208-1566

Listed as

Revive Hospice Care Group, Inc.CCN 751727

Ownership

For-Profit

Certified

Aug 19, 2015

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 5

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

Owners & managing parties with NPI records 2

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

• Xu Long He, D.O

  • Internal Medicine Physician
  • Fontana, CA
  • NPI 1568773448

  W-2 Managing Employee

  CMS ownership
• Walter Tsang, MD

  • Hematology & Oncology Physician
  • Highland, CA
  • NPI 1285861799

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 3

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

• Paula Bailey-Walton, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1174646590

  Hospice

  Care Compare affiliation
• Xu Long He, D.O

  • Internal Medicine Physician
  • Fontana, CA
  • NPI 1568773448

  Hospice

  Care Compare affiliation
• Walter Tsang, MD

  • Hematology & Oncology Physician
  • Highland, CA
  • NPI 1285861799

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1700216694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3430 OCEAN VIEW BLVD STE F",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081566",
            "telephone_number": "818-909-3444",
            "fax_number": "818-909-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3430 OCEAN VIEW BLVD STE F",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081566",
            "telephone_number": "818-909-3444",
            "fax_number": "818-909-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HOSPICE CARE GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "PENESYAN",
        "authorized_official_first_name": "ALIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-909-3444"
    },
    "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 Glendale, CA
• Providers in Glendale, 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 Feb 23, 2023; 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.