- Enrollment id
- O20210412002358
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1376160358
- Multiple npi flag
- N
- Ccn
- A11756
- Associate id
- 1355759374
- Organization name
- LIVING ANGELS HOSPICE CARE
- Incorporation date
- 2020-05-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 208C-1
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632360