- Enrollment id
- O20241113001611
- Enrollment state
- OH
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1013780733
- Multiple npi flag
- N
- Ccn
- 361642
- Associate id
- 3779017728
- Organization name
- MENORAH LIFE HOSPICE LLC
- Incorporation date
- 2023-09-01
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 27100 CEDAR RD
- City
- BEACHWOOD
- State
- OH
- Zip code
- 441221109