Davida Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

DAVIDA HOSPICE, INC.

Practice address

11428 Artesia Blvd Ste 13
Artesia, CA 90701-3872

Phone

(562) 403-3133

NPI assigned

May 11, 2020

Last updated

May 11, 2020By 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

Gaspan Madjarian

Title

Ceo/President

Phone

(562) 403-3133

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912529181. Details of each certification follow.

• CCN B51702 Hospice · Active · Details

Hospice certification: CCN B51702

Legal name

DAVIDA HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 23, 2023

Last certification

May 12, 2023

Organization structure

CorporationProprietary

Incorporated

Apr 9, 2019 in CA

Enrollment address

11428 Artesia Blvd
Ste 13
Artesia, CA 90701-3872

Listed as

Davida Hospice, Inc.CCN B51702 · All quality measures

Certified

May 23, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 3

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 1

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

• Phillip Tafoya, MD

  • Specialist
  • Temecula, CA
  • NPI 1073509469

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 1

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

• Phillip Tafoya, MD

  • Specialist
  • Temecula, CA
  • NPI 1073509469

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1912529181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11428 ARTESIA BLVD STE 13",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907013872",
            "telephone_number": "562-403-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11428 ARTESIA BLVD STE 13",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907013872",
            "telephone_number": "562-403-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIDA HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "MADJARIAN",
        "authorized_official_first_name": "GASPAN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "562-403-3133"
    },
    "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 Artesia, CA
• Providers in Artesia, 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 May 11, 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.