- Enrollment id
- O20220124001215
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1770184814
- Multiple npi flag
- N
- Ccn
- B41708
- Associate id
- 6103218219
- Organization name
- MERCY VILLA HOSPICE INC
- Incorporation date
- 2020-08-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 9700 RESEDA BLVD
- Address line 2
- STE 100
- City
- NORTHRIDGE
- State
- CA
- Zip code
- 913245519