- Enrollment id
- O20040511001829
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1629270699
- Multiple npi flag
- N
- Ccn
- 551530
- Associate id
- 7012906209
- Organization name
- EVERGREEN HOSPICE CARE, INC.
- Incorporation date
- 2004-03-11
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17215 STUDEBAKER RD
- Address line 2
- SUITE #100
- City
- CERRITOS
- State
- CA
- Zip code
- 907032521