- Enrollment id
- O20060501000662
- Enrollment state
- FL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1376510065
- Multiple npi flag
- N
- Ccn
- 101522
- Associate id
- 4284644543
- Organization name
- HALIFAX HOSPICE INC
- Doing business as name
- HALIFAX HEALTH HOSPICE
- Incorporation date
- 1984-12-21
- Incorporation state
- FL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 3800 WOODBRIAR TRL
- City
- PORT ORANGE
- State
- FL
- Zip code
- 321299626