| Organization Name: | FAIRY HOSPICE CARE, INC. |
| NPI Number: | 1558759597 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SARGIS KOPUSHYAN (PRESIDENT/CEO) |
| Mailing Address: | 512 E Wilson Ave Ste 303 Glendale |
| State: | CA US |
| Postal Code: | 912064351 |
| Phone Number: | 8189605836 |
| Fax Number: | 8187962567 |
| NPI Enumeration Date: | 12/29/2014 |
| NPI Last Update Date: | 12/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |