- Enrollment id
- O20201023000314
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1053926311
- Multiple npi flag
- N
- Ccn
- B31703
- Associate id
- 9032539465
- Organization name
- COMFORTER HOSPICE INC
- Doing business as name
- SOCAL PREMIUM HOSPICE CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 16661 VENTURA BLVD
- Address line 2
- STE 213
- City
- ENCINO
- State
- CA
- Zip code
- 914361940