- Enrollment id
- O20141203001540
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1619301553
- Multiple npi flag
- N
- Ccn
- 751675
- Associate id
- 0547582413
- Organization name
- MAKA HOSPICE, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7120 HAYVENHURST AVE
- Address line 2
- STE 112
- City
- VAN NUYS
- State
- CA
- Zip code
- 914063813