- Enrollment id
- O20210820000716
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1710575998
- Multiple npi flag
- N
- Ccn
- B51513
- Associate id
- 8426453077
- Organization name
- GOLDEN STATE HOSPICE CARE
- Incorporation date
- 2020-11-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4405 W RIVERSIDE DR
- Address line 2
- STE 203
- City
- BURBANK
- State
- CA
- Zip code
- 915054050