- Enrollment id
- O20040824000483
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1255549473
- Multiple npi flag
- N
- Ccn
- 551500
- Associate id
- 9335113463
- Organization name
- ST ANTHONY HOSPICE
- Incorporation date
- 2001-02-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 512 E WILSON AVE
- Address line 2
- #208
- City
- GLENDALE
- State
- CA
- Zip code
- 912064351