- Enrollment id
- O20200929003663
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1821602822
- Multiple npi flag
- N
- Ccn
- B31769
- Associate id
- 6204255995
- Organization name
- REAL MIND HOSPICE & PALLIATIVE CARE INC
- Incorporation date
- 2020-08-17
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15130 VENTURA BLVD
- Address line 2
- STE 318
- City
- SHERMAN OAKS
- State
- CA
- Zip code
- 914033378