- Enrollment id
- O20120113000038
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1093082281
- Multiple npi flag
- N
- Ccn
- 551703
- Associate id
- 4688841737
- Organization name
- ANGELS ON EARTH HOSPICE
- Incorporation date
- 2011-05-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 202A
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632339