- Enrollment id
- O20100226000770
- Enrollment state
- NM
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1184952368
- Multiple npi flag
- N
- Ccn
- 321566
- Associate id
- 9234041708
- Organization name
- PRESBYTERIAN HEALTHCARE SERVICES
- Doing business as name
- TUCUMCARI HOSPICE
- Organization type structure
- OTHER
- Organization other type text
- 501(C)(3) TAX EXEMPT
- Proprietary nonprofit
- N
- Address line 1
- 301 E MIEL DE LUNA
- City
- TUCUMCARI
- State
- NM
- Zip code
- 884012858