- Enrollment id
- O20210204000783
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1407471535
- Multiple npi flag
- N
- Ccn
- B21708
- Associate id
- 0446664395
- Organization name
- BONA FIDE HOSPICE INC
- Incorporation date
- 2020-01-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5315 LAUREL CANYON BLVD
- Address line 2
- STE 201
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916074916