- Enrollment id
- O20210211002026
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1760095897
- Multiple npi flag
- N
- Ccn
- B51725
- Associate id
- 2062827645
- Organization name
- MID VALLEY HOSPICE CARE INC
- Incorporation date
- 2020-07-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4444 W RIVERSIDE DR
- Address line 2
- STE 206
- City
- BURBANK
- State
- CA
- Zip code
- 915054048