- Enrollment id
- O20221005003108
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1336895598
- Multiple npi flag
- N
- Ccn
- A91584
- Associate id
- 5597141119
- Organization name
- QUIET WATERS HOSPICE, LLC
- Incorporation date
- 2022-01-28
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 10707 CORPORATE DR
- Address line 2
- STE 114
- City
- STAFFORD
- State
- TX
- Zip code
- 774774001