- Enrollment id
- O20050727000648
- Enrollment state
- MN
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1154407005
- Multiple npi flag
- N
- Ccn
- 241540
- Associate id
- 9830127356
- Organization name
- HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
- Doing business as name
- GOOD SHEPHERD HOSPICE
- Incorporation date
- 1941-02-25
- Incorporation state
- MN
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 503 E LINCOLN ST
- City
- HENDRICKS
- State
- MN
- Zip code
- 561369598