- Enrollment id
- O20160831002973
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1437597150
- Multiple npi flag
- N
- Ccn
- 741576
- Associate id
- 5991091894
- Organization name
- FAIRMONT HOSPICE LLC
- Incorporation date
- 2016-03-22
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 300 JACKSON ST
- City
- RICHMOND
- State
- TX
- Zip code
- 774693109