- Enrollment id
- O20220802000347
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1932777646
- Multiple npi flag
- N
- Ccn
- B51679
- Associate id
- 0244612620
- Organization name
- MEDIQ HOSPICE AND PALLIATIVE CARE
- Incorporation date
- 2020-08-04
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3151 CAHUENGA BLVD W
- Address line 2
- STE 220
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900681749