- Enrollment id
- O20160106001122
- Enrollment state
- MO
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1508241001
- Multiple npi flag
- N
- Ccn
- 261665
- Associate id
- 4981906054
- Organization name
- FAITH HOSPICE OF THE OZARKS LLC
- Incorporation date
- 2015-06-21
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 123 JOHNSTOWN DR
- City
- ROGERSVILLE
- State
- MO
- Zip code
- 657429366