Provider Demographics
NPI:1902993140
Name:ALTA VERDUGO CONSULTING INC
Entity Type:Organization
Organization Name:ALTA VERDUGO CONSULTING INC
Other - Org Name:VERDUGO HOSPICE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIKORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-257-5715
Mailing Address - Street 1:4170 VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3821
Mailing Address - Country:US
Mailing Address - Phone:323-257-5715
Mailing Address - Fax:
Practice Address - Street 1:4170 VERDUGO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3821
Practice Address - Country:US
Practice Address - Phone:323-257-5715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01772FMedicaid
CA051772Medicare ID - Type UnspecifiedHOSPICE PROVIDER