- Enrollment id
- O20201026000016
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1073120887
- Multiple npi flag
- N
- Ccn
- B31573
- Associate id
- 0840610242
- Organization name
- DIAMOND KEY HOSPICE, INC.
- Incorporation date
- 2020-09-11
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 19634 VENTURA BLVD
- Address line 2
- STE 112
- City
- TARZANA
- State
- CA
- Zip code
- 913562966