- Enrollment id
- O20201217002720
- Enrollment state
- OH
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1134267081
- Multiple npi flag
- N
- Ccn
- 361604
- Associate id
- 0547672446
- Organization name
- MIRACLE CITY HOSPICE LLC
- Incorporation date
- 2020-09-16
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9150 S HILLS BLVD
- Address line 2
- STE 100
- City
- BROADVIEW HEIGHTS
- State
- OH
- Zip code
- 441473511