- Enrollment id
- O20241008001029
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1962015263
- Multiple npi flag
- N
- Ccn
- D61549
- Associate id
- 5395164230
- Organization name
- ST GILBERT HOSPICE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE 206B
- City
- GLENDALE
- State
- CA
- Zip code
- 912033136