- Enrollment id
- O20241220003603
- Enrollment state
- NV
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1053176461
- Multiple npi flag
- N
- Ccn
- 291720
- Associate id
- 3870020332
- Organization name
- GOODWILL HEALTH CARE LLC
- Doing business as name
- GOODWILL HOSPICE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6655 W SAHARA AVENUE
- Address line 2
- SUITE B200-113,114
- City
- LAS VEGAS
- State
- NV
- Zip code
- 89146