- Enrollment id
- O20190710002899
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1225444193
- Multiple npi flag
- N
- Ccn
- A01658
- Associate id
- 7517292725
- Organization name
- SERENE HOSPICE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 20953 DEVONSHIRE ST
- Address line 2
- STE 5
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913112367