- Enrollment id
- O20080308000002
- Enrollment state
- OH
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1255333753
- Multiple npi flag
- N
- Ccn
- 361503
- Associate id
- 3476539982
- Organization name
- HOSPICE OF THE WESTERN RESERVE INC
- Incorporation date
- 1978-03-10
- Incorporation state
- OH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 17876 ST. CLAIR AVE.
- City
- CLEVELAND
- State
- OH
- Zip code
- 441102602