- Enrollment id
- O20191030002099
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1083256036
- Multiple npi flag
- N
- Ccn
- A11661
- Associate id
- 8729310446
- Organization name
- DEVINE HOSPICE CARE INC
- Incorporation date
- 2019-09-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 20945 DEVONSHIRE ST
- Address line 2
- STE 201C
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913112370