1790308682 NPI number — BRIGHT ANGEL HOSPICE

Table of content: (NPI 1790308682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790308682 NPI number — BRIGHT ANGEL HOSPICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT ANGEL HOSPICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790308682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6044 VINELAND AVE # NUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91606-4912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
747-205-2552
Provider Business Mailing Address Fax Number:
747-205-2085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6044 VINELAND AVE # NUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-205-2552
Provider Business Practice Location Address Fax Number:
747-205-2085
Provider Enumeration Date:
05/26/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZURNACHYAN
Authorized Official First Name:
GEVORG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
747-205-2552

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 550006924 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 630020572 . This is a "FACILITY ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".