Provider Demographics
NPI:1447834130
Name:VIDA HOSPICE AND PALLIATIVE CARE, INC
Entity type:Organization
Organization Name:VIDA HOSPICE AND PALLIATIVE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-387-2008
Mailing Address - Street 1:4225 VALLEY FAIR ST STE 201B
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2955
Mailing Address - Country:US
Mailing Address - Phone:805-387-2008
Mailing Address - Fax:805-206-3005
Practice Address - Street 1:4225 VALLEY FAIR ST STE 201B
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2955
Practice Address - Country:US
Practice Address - Phone:805-387-2008
Practice Address - Fax:805-206-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based