- Enrollment id
- O20120302000555
- Enrollment state
- WY
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1144359423
- Multiple npi flag
- N
- Ccn
- 531510
- Associate id
- 2163405440
- Organization name
- MEMORIAL HOSPITAL OF SHERIDAN COUNTY
- Doing business as name
- SHERIDAN MEMORIAL HOSPITAL HOSPICE
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Address line 1
- 1401 W 5TH ST
- City
- SHERIDAN
- State
- WY
- Zip code
- 828012705