- Enrollment id
- O20140908000040
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1699106120
- Multiple npi flag
- N
- Ccn
- A01565
- Associate id
- 9133347008
- Organization name
- LUCKY PALLIATIVE SERVICES INCORPORATED
- Incorporation date
- 2013-12-03
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 20944 SHERMAN WAY
- Address line 2
- STE 204
- City
- CANOGA PARK
- State
- CA
- Zip code
- 913033661