- Enrollment id
- O20200813001642
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1134747223
- Multiple npi flag
- N
- Ccn
- B31630
- Associate id
- 8820414451
- Organization name
- GREEN WAY HOSPICE INC
- Incorporation date
- 2020-05-26
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7630 VINELAND AVE
- Address line 2
- STE 210A
- City
- SUN VALLEY
- State
- CA
- Zip code
- 913524535