- Enrollment id
- O20220628000692
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1417536475
- Multiple npi flag
- N
- Ccn
- B41728
- Associate id
- 2860871480
- Organization name
- TINY OASIS HOSPICE INC
- Incorporation date
- 2021-01-10
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2600 FOOTHILL BLVD
- Address line 2
- STE 111
- City
- LA CRESCENTA
- State
- CA
- Zip code
- 912144501