- Enrollment id
- O20201026003351
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1043780075
- Multiple npi flag
- N
- Ccn
- 971576
- Associate id
- 2264852524
- Organization name
- PAX ET VITA HOSPICE AGENCY LLC
- Doing business as name
- PAX ET VITA HOSPICE AGENCY LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 830 JULIE RIVERS DR
- Address line 2
- STE 602
- City
- SUGAR LAND
- State
- TX
- Zip code
- 774782878