- Enrollment id
- O20130628000134
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1124368808
- Multiple npi flag
- N
- Ccn
- 751500
- Associate id
- 2567602303
- Organization name
- SUNCREST HOSPICE SAN JOSE, LLC
- Doing business as name
- SUNCREST HEALTH SERVICES
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3215 SKYWAY CT
- City
- FREMONT
- State
- CA
- Zip code
- 945395951