- Enrollment id
- O20130416000473
- Enrollment state
- WI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1508209438
- Multiple npi flag
- N
- Ccn
- 521596
- Associate id
- 1850537978
- Organization name
- HOMETOWN HOSPICE & HOMECARE INC
- Doing business as name
- ST CROIX HOSPICE
- Incorporation date
- 2013-03-19
- Incorporation state
- WI
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- N16W23217 STONE RIDGE DR
- Address line 2
- STE 270
- City
- WAUKESHA
- State
- WI
- Zip code
- 531881171