- Enrollment id
- O20200714001491
- Enrollment state
- CA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1962028118
- Multiple npi flag
- N
- Ccn
- B41631
- Associate id
- 0244653913
- Organization name
- GRACIOUS NURSES HOSPICE
- Incorporation date
- 2020-06-18
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 205D
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112398