- Enrollment id
- O20200515001335
- Enrollment state
- MN
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1114094620
- Multiple npi flag
- N
- Ccn
- 241538
- Associate id
- 5890126726
- Organization name
- HEALTHPARTNERS RC
- Doing business as name
- OLIVIA HOSPITAL & CLINIC - HOSPICE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 100 HEALTHY WAY
- Address line 2
- MAILSTOP 36300A
- City
- OLIVIA
- State
- MN
- Zip code
- 562771117