- Enrollment id
- O20210831001958
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1659983625
- Multiple npi flag
- N
- Ccn
- B51559
- Associate id
- 8022414085
- Organization name
- MIMAS HOSPICE AND PALLIATIVE CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3171 LOS FELIZ BLVD
- Address line 2
- STE 303E
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900391537