- Enrollment id
- O20050124000774
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1205939816
- Multiple npi flag
- N
- Ccn
- 451799
- Associate id
- 0648220038
- Organization name
- GOOD SHEPHERD HOSPICE OF DALLAS, LLC
- Incorporation date
- 2004-08-27
- Incorporation state
- OK
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 7920 BELT LINE RD
- Address line 2
- STE 760
- City
- DALLAS
- State
- TX
- Zip code
- 752548188