- Enrollment id
- O20220610002559
- Enrollment state
- TN
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1053313874
- Multiple npi flag
- N
- Ccn
- 441504
- Associate id
- 8123406642
- Organization name
- HOSPICE OF CHATTANOOGA HOLDINGS, LLC
- Doing business as name
- HOSPICE OF CHATTANOOGA
- Incorporation date
- 2021-06-23
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2030 HAMILTON PLACE BLVD
- Address line 2
- STE 220
- City
- CHATTANOOGA
- State
- TN
- Zip code
- 374216040