- Enrollment id
- O20190325001000
- Enrollment state
- PA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1407335706
- Multiple npi flag
- N
- Ccn
- 391770
- Associate id
- 8325388630
- Organization name
- CONSTELLATION HOSPICE PA LLC
- Doing business as name
- CONSTELLATION HOSPICE
- Incorporation date
- 2018-06-01
- Incorporation state
- PA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 660 NEWTOWN YARDLEY RD
- Address line 2
- STE 105
- City
- NEWTOWN
- State
- PA
- Zip code
- 189404009