Provider Demographics
NPI:1447281456
Name:PANACEA HHC INC
Entity type:Organization
Organization Name:PANACEA HHC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1323-953-9392
Mailing Address - Street 1:4652 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5408
Mailing Address - Country:US
Mailing Address - Phone:323-953-9392
Mailing Address - Fax:323-315-2205
Practice Address - Street 1:4652 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5408
Practice Address - Country:US
Practice Address - Phone:323-953-9392
Practice Address - Fax:323-315-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000294251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058404Medicare Oscar/Certification