- Enrollment id
- O20220419001162
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1033880075
- Multiple npi flag
- N
- Ccn
- 971778
- Associate id
- 2163819335
- Organization name
- PEACEFUL HOPE HOSPICE AND PALLIATIVE CARE LLC
- Incorporation date
- 2021-09-18
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 621 AVENUE G
- City
- DALLAS
- State
- TX
- Zip code
- 752033901