- Enrollment id
- O20190226001810
- Enrollment state
- PA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1043783236
- Multiple npi flag
- N
- Ccn
- 391772
- Associate id
- 1759620354
- Organization name
- SIGNAL PA HOSPICE LLC
- Doing business as name
- PERSONAL HOME HEALTHCARE AND HOSPICE
- Incorporation date
- 2018-10-05
- Incorporation state
- PA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 233 MAIN STREET
- City
- BLAKELY
- State
- PA
- Zip code
- 18447