- Enrollment id
- O20180214001011
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1689189110
- Multiple npi flag
- N
- Ccn
- A01519
- Associate id
- 4183901978
- Organization name
- COLUSA MEDICAL CENTER, LLC
- Doing business as name
- COLUSA MEDICAL CENTER - HOSPICE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 199 E WEBSTER ST
- City
- COLUSA
- State
- CA
- Zip code
- 959322954