- Enrollment id
- O20160125002223
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1245603109
- Multiple npi flag
- N
- Ccn
- 921600
- Associate id
- 5193028140
- Organization name
- CALSTRO HOSPICE INC
- Incorporation date
- 2018-08-27
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 108B
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632331