- Enrollment id
- O20110815000310
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1194003277
- Multiple npi flag
- N
- Ccn
- 551730
- Associate id
- 9931378601
- Organization name
- ANGEL'S SMILE HOSPICE, INC.
- Incorporation date
- 2011-06-01
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2252 BEVERLY BLVD
- Address line 2
- STE 210
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900572225