- Enrollment id
- O20200624003305
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1154976959
- Multiple npi flag
- N
- Ccn
- 971625
- Associate id
- 8426470147
- Organization name
- SOUTHERN HOSPICE AND PALLIATIVE CARE INC
- Doing business as name
- SOUTHERN HOSPICE AND PALLIATIVE CARE.
- Incorporation date
- 2018-04-10
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1505 HIGHWAY 6 SOUTH
- Address line 2
- # 215
- City
- HOUSTON
- State
- TX
- Zip code
- 770771700