- Enrollment id
- O20200401003494
- Enrollment state
- IN
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1205479383
- Multiple npi flag
- N
- Ccn
- 151631
- Associate id
- 5698104255
- Organization name
- ELEOS,LLC
- Doing business as name
- ELEOS HOSPICE CARE
- Incorporation date
- 2019-07-18
- Incorporation state
- IN
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4432 ARDMORE AVE
- Address line 2
- UNIT B
- City
- FORT WAYNE
- State
- IN
- Zip code
- 468099722