- Enrollment id
- O20150506001017
- Enrollment state
- ID
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1114317153
- Multiple npi flag
- N
- Ccn
- 131553
- Associate id
- 1759426075
- Organization name
- HPA IDAHO, LLC
- Doing business as name
- HARRISON'S HOPE HOSPICE
- Incorporation date
- 2010-01-28
- Incorporation state
- ID
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3137 S MERIDIAN RD
- Address line 2
- STE 120
- City
- MERIDIAN
- State
- ID
- Zip code
- 836427094