Baby Boomers Hospice Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

BABY BOOMERS HOSPICE CARE INC

Practice address

17817 Chatsworth St Unit 220
Granada Hills, CA 91344-5612

Phone

(877) 354-5554

NPI assigned

Nov 2, 2020

Organization subpart

No

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

Authorized official

Name

Mariam Avetisyan

Title

Ceo

Phone

(877) 354-5554

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B31759

Legal name

BABY BOOMERS HOSPICE CARE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Feb 16, 2022

Last certification

Feb 16, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Jul 20, 2020 in CA

Enrollment address

17817 Chatsworth St
Unit 220
Granada Hills, CA 91344-5612

Listed as

Baby Boomers Hospice Care IncCCN B31759

Certified

Feb 16, 2022

Medicare certification status

ActiveFrom the Provider of Services file

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.

• Prode P Pascual, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Norwalk, CA
  • NPI 1558454595

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1780285395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17817 CHATSWORTH ST UNIT 220",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913445612",
            "telephone_number": "877-354-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17817 CHATSWORTH ST UNIT 220",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913445612",
            "telephone_number": "877-354-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BABY BOOMERS HOSPICE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A",
        "authorized_official_last_name": "AVETISYAN",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-354-5554"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dzhoni Avetisyan, D.D.S.
• Diamaya Avila
• Brian Barrios Ayuste, M.D.
• Minoo Azadeh, MD
• Joshua Azali
• Karen Baghdasaryan, DDS
• Margarit Baghdasaryan, FNP
• Lori Baghdassarian
• Brandy Bailey, MCW II
• Edward Anthony Bakchadjian, EMT

• Community Based Hospice Care Agency in Granada Hills, CA
• Providers in Granada Hills, 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 Nov 2, 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.