- Enrollment id
- O20120511000248
- Enrollment state
- OH
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1437432929
- Multiple npi flag
- N
- Ccn
- 361664
- Associate id
- 3678736576
- Organization name
- QUEEN CITY HOSPICE, LLC
- Doing business as name
- QUEEN CITY HOSPICE
- Incorporation date
- 2011-04-14
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4605 DUKE DR
- Address line 2
- STE 220
- City
- MASON
- State
- OH
- Zip code
- 450401553