- Enrollment id
- O20170526002057
- Enrollment state
- OH
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1316484785
- Multiple npi flag
- N
- Ccn
- 361704
- Associate id
- 1052688868
- Organization name
- AVALON HOSPICE OHIO, LLC
- Doing business as name
- GENTIVA II
- Incorporation date
- 2017-02-10
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4010 EXECUTIVE PARK DR
- Address line 2
- STE 225
- City
- CINCINNATI
- State
- OH
- Zip code
- 452414010