- Enrollment id
- O20161011000414
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1487101739
- Multiple npi flag
- N
- Ccn
- 921632
- Associate id
- 9638467491
- Organization name
- FREE SPIRIT HOSPICE INC
- Doing business as name
- AASTA HOSPICE
- Incorporation date
- 2016-07-19
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5924 E LOS ANGELES AVE
- Address line 2
- STE R
- City
- SIMI VALLEY
- State
- CA
- Zip code
- 930635526