- Enrollment id
- O20220623002184
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1336746684
- Multiple npi flag
- N
- Ccn
- B51673
- Associate id
- 1850707613
- Organization name
- COASTLINE HOSPICE INC
- Incorporation date
- 2020-06-23
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7630 VINELAND AVE
- Address line 2
- STE 207A
- City
- SUN VALLEY
- State
- CA
- Zip code
- 913524535