- Enrollment id
- O20200128003050
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1629623509
- Multiple npi flag
- N
- Ccn
- A11507
- Associate id
- 2163858895
- Organization name
- FIRST AMERICAN HOSPICE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 436 W COLORADO ST
- Address line 2
- STE 209
- City
- GLENDALE
- State
- CA
- Zip code
- 912043074