- Enrollment id
- O20131023002015
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1720353535
- Multiple npi flag
- N
- Ccn
- 751552
- Associate id
- 7810122009
- Organization name
- GIBRALTAR HOSPICE, INC.
- Incorporation date
- 2019-11-18
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 22141 VENTURA BLVD
- Address line 2
- STE 301
- City
- WOODLAND HILLS
- State
- CA
- Zip code
- 913641663