- Enrollment id
- O20201022000496
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1699383232
- Multiple npi flag
- N
- Ccn
- B31736
- Associate id
- 0143640615
- Organization name
- GOODWILL HEALTHCARE SERVICES INC.
- Incorporation date
- 2020-06-26
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2600 FOOTHILL BLVD
- Address line 2
- STE 104
- City
- LA CRESCENTA
- State
- CA
- Zip code
- 912144578