- Enrollment id
- O20090114000144
- Enrollment state
- FL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1124171350
- Multiple npi flag
- N
- Ccn
- 101507
- Associate id
- 9335202589
- Organization name
- LIFEPATH HOSPICE, INC.
- Doing business as name
- LIFEPATH HOSPICE
- Incorporation date
- 2006-07-19
- Incorporation state
- FL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 12470 TELECOM DR
- Address line 2
- STE 400
- City
- TEMPLE TERRACE
- State
- FL
- Zip code
- 336370904