- Enrollment id
- O20210201001046
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1629665088
- Multiple npi flag
- N
- Ccn
- B51697
- Associate id
- 7012321177
- Organization name
- PROMISED HOPE HOSPICE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5311 TOPANGA CANYON BLVD
- Address line 2
- STE 208
- City
- WOODLAND HILLS
- State
- CA
- Zip code
- 913641740