- Enrollment id
- O20211014000528
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1649880964
- Multiple npi flag
- N
- Ccn
- B51618
- Associate id
- 4880092378
- Organization name
- SUMMER BREEZE HEALTHCARE
- Incorporation date
- 2020-06-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 106C-3
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632336