- Enrollment id
- O20171012002030
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1033549936
- Multiple npi flag
- N
- Ccn
- A01543
- Associate id
- 2961777248
- Organization name
- DIVINE GRACE HOSPICE, INC.
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4766 PARK GRANADA
- Address line 2
- STE 112
- City
- CALABASAS
- State
- CA
- Zip code
- 913023347