- Enrollment id
- O20201023002497
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1508463225
- Multiple npi flag
- N
- Ccn
- B51751
- Associate id
- 5092135475
- Organization name
- SERANI HOSPICE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1010 N CENTRAL AVE
- Address line 2
- UNIT 301
- City
- GLENDALE
- State
- CA
- Zip code
- 912022937