- Enrollment id
- O20110208000175
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1023346343
- Multiple npi flag
- N
- Ccn
- 671698
- Associate id
- 6901086040
- Organization name
- DELTACARE HOSPICE, LLC
- Doing business as name
- ICON HOSPICE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3132 W MILLER RD
- Address line 2
- # B
- City
- GARLAND
- State
- TX
- Zip code
- 750416108