- Enrollment id
- O20141218001518
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1003212010
- Multiple npi flag
- N
- Ccn
- 751673
- Associate id
- 6608199872
- Organization name
- SERENITY HOSPICE CARE PROVIDER, INC
- Doing business as name
- GOOD HEART HOSPICE & PALLIATIVE CARE SIMI VALLEY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2139 TAPO ST
- Address line 2
- STE 212
- City
- SIMI VALLEY
- State
- CA
- Zip code
- 930633476