- Enrollment id
- O20210809001807
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1922608959
- Multiple npi flag
- N
- Ccn
- B31683
- Associate id
- 6002210374
- Organization name
- PRIMAL CARE HOSPICE INC
- Incorporation date
- 2020-09-03
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 815 S CENTRAL AVE
- Address line 2
- STE 26
- City
- GLENDALE
- State
- CA
- Zip code
- 912044301