- Enrollment id
- O20200403001292
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1801452180
- Multiple npi flag
- N
- Ccn
- A11711
- Associate id
- 8426487984
- Organization name
- GOOD LIFE PALLIATIVE CARE
- Incorporation date
- 2019-05-03
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 20953 DEVONSHIRE ST
- Address line 2
- STE 8A
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913112371