- Enrollment id
- O20220415001363
- Enrollment state
- IL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1417494212
- Multiple npi flag
- N
- Ccn
- 141719
- Associate id
- 5698004976
- Organization name
- ENTERA HOSPICE INC
- Incorporation date
- 2016-12-02
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 10700 W HIGGINS RD
- Address line 2
- STE 340
- City
- ROSEMONT
- State
- IL
- Zip code
- 600183729