- Enrollment id
- O20210526001588
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1700403086
- Multiple npi flag
- N
- Ccn
- B21712
- Associate id
- 6800295718
- Organization name
- AMPM HOSPICE INC
- Incorporation date
- 2020-05-07
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14542 VENTURA BLVD
- Address line 2
- STE 202
- City
- SHERMAN OAKS
- State
- CA
- Zip code
- 914035520