- Enrollment id
- O20210125000389
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1093337784
- Multiple npi flag
- N
- Ccn
- B41793
- Associate id
- 9739593211
- Organization name
- BRIGHT SOURCE HOSPICE LLC
- Incorporation date
- 2020-04-28
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 22024 LASSEN ST
- Address line 2
- OFC 113
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913113600