- Enrollment id
- O20230403001549
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1639776479
- Multiple npi flag
- N
- Ccn
- B51754
- Associate id
- 4880066208
- Organization name
- VENERABLE HOSPICE CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 512 E WILSON AVE
- Address line 2
- STE 202
- City
- GLENDALE
- State
- CA
- Zip code
- 912064351