- Enrollment id
- O20230310001049
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1225630486
- Multiple npi flag
- N
- Ccn
- D61526
- Associate id
- 8123491271
- Organization name
- IMPACT HOSPICE CARE INC
- Incorporation date
- 2020-11-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 16430 VENTURA BLVD
- Address line 2
- STE 200A
- City
- ENCINO
- State
- CA
- Zip code
- 914362135