- Enrollment id
- O20170607000639
- Enrollment state
- MA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1336675263
- Multiple npi flag
- N
- Ccn
- 221604
- Associate id
- 4587931977
- Organization name
- WEST RIVER HOSPICE, LLC
- Doing business as name
- WEST RIVER HOSPICE
- Incorporation date
- 2016-11-22
- Incorporation state
- MA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 63 KENDRICK STREET
- Address line 2
- ONE CHARLES RIVER PLACE
- City
- NEEDHAM
- State
- MA
- Zip code
- 024942708