- Enrollment id
- O20240509002097
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1275159303
- Multiple npi flag
- N
- Ccn
- D61552
- Associate id
- 9234537382
- Organization name
- CREST HOSPICE CARE, INC.
- Incorporation date
- 2020-03-23
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE 512
- City
- GLENDALE
- State
- CA
- Zip code
- 912032230