- Enrollment id
- O20201130001866
- Enrollment state
- IL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1174144463
- Multiple npi flag
- N
- Ccn
- 141706
- Associate id
- 5597176362
- Organization name
- FIVE STAR HOSPICE AND PALLIATIVE CARE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2500 W HIGGINS RD
- Address line 2
- STE 1165
- City
- HOFFMAN ESTATES
- State
- IL
- Zip code
- 601692050