- Enrollment id
- O20201109003151
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1760004147
- Multiple npi flag
- N
- Ccn
- B21630
- Associate id
- 7214347939
- Organization name
- LADY OF JOY HOSPICE INC
- Incorporation date
- 2020-03-27
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 103A-6
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632330