- Enrollment id
- O20220124000763
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1467048629
- Multiple npi flag
- N
- Ccn
- B41644
- Associate id
- 3375935471
- Organization name
- HEAVENLY HOSPICE CARE CENTER INC
- Doing business as name
- SACRED JOURNEY HOSPICE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6308 WOODMAN AVE
- Address line 2
- STE 218
- City
- VAN NUYS
- State
- CA
- Zip code
- 914012347