- Enrollment id
- O20201104001766
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1144828500
- Multiple npi flag
- N
- Ccn
- B31523
- Associate id
- 4183034085
- Organization name
- IE COMMUNITY HOSPICE, INC.
- Incorporation date
- 2020-08-07
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 600 N MOUNTAIN AVE
- Address line 2
- STE D105
- City
- UPLAND
- State
- CA
- Zip code
- 917864359