- Enrollment id
- O20110323000761
- Enrollment state
- ID
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1417253873
- Multiple npi flag
- N
- Ccn
- 131570
- Associate id
- 0648453902
- Organization name
- AUBURN CREST HOSPICE TREASURE VALLEY, LLC
- Incorporation date
- 2011-01-28
- Incorporation state
- ID
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3751 N CLOVERDALE RD
- City
- BOISE
- State
- ID
- Zip code
- 837133610