- Enrollment id
- O20140822002485
- Enrollment state
- UT
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1407268485
- Multiple npi flag
- N
- Ccn
- 461611
- Associate id
- 5698993202
- Organization name
- INTEGRATED SENIOR CARE HOSPICE
- Doing business as name
- PEAK HOSPICE
- Incorporation date
- 2014-05-09
- Incorporation state
- UT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 616 S RIVER RD
- Address line 2
- STE 200
- City
- ST GEORGE
- State
- UT
- Zip code
- 847902105