- Enrollment id
- O20200903001432
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1831721893
- Multiple npi flag
- N
- Ccn
- A11716
- Associate id
- 3476970534
- Organization name
- GREEN PARADISE HOSPICE CARE INC
- Incorporation date
- 2020-01-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5658 SEPULVEDA BLVD
- Address line 2
- STE 201
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112951