- Enrollment id
- O20231023003462
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1396431730
- Multiple npi flag
- N
- Ccn
- A91738
- Associate id
- 6709232028
- Organization name
- LIFELINE HOSPICE CARE INC
- Incorporation date
- 2023-03-22
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 9304 FOREST LN
- Address line 2
- STE N165B
- City
- DALLAS
- State
- TX
- Zip code
- 752436238