Crown Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

CROWN HOSPICE, INC.

Practice address

12722 Riverside Dr Ste 105
Valley Village, CA 91607-3370

Phone

(818) 646-7076

Fax

(818) 688-5071

NPI assigned

Mar 19, 2021

Last updated

Mar 19, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sergey Bedrossian

Title

Ceo

Phone

(818) 646-7076

Specialties & licenses 1

Addresses

Other names 1

• Crown Hospice, Inc. Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871179937. Details of each certification follow.

• CCN B41662 Hospice · Active · Details

Hospice certification: CCN B41662

Legal name

CROWN HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 5, 2022

Last certification

Aug 5, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 11, 2021 in CA

Enrollment address

12722 Riverside Dr
Ste 105
Valley Village, CA 91607-3370

Listed as

Crown Hospice, Inc.CCN B41662 · All quality measures

Certified

Aug 5, 2022

Medicare certification status

ActiveFrom the Provider of Services file

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.

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

{
    "created_epoch": "1616112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1871179937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12722 RIVERSIDE DR STE 105",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916073370",
            "telephone_number": "818-646-7076",
            "fax_number": "818-688-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12722 RIVERSIDE DR STE 105",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916073370",
            "telephone_number": "818-646-7076",
            "fax_number": "818-688-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-19",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "BEDROSSIAN",
        "authorized_official_first_name": "SERGEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-646-7076",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crown Hospice, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.