- Enrollment id
- O20170614001503
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1366985376
- Multiple npi flag
- N
- Ccn
- 741698
- Associate id
- 9032487160
- Organization name
- AUTUMNCARE HEALTH SERVICES LLC
- Doing business as name
- AUTUMNCARE HOSPICE
- Incorporation date
- 2016-11-18
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 10701 CORPORATE DR
- Address line 2
- STE 340-105
- City
- STAFFORD
- State
- TX
- Zip code
- 774774096