- Enrollment id
- O20210217000383
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1518578517
- Multiple npi flag
- N
- Ccn
- 971647
- Associate id
- 7810302296
- Organization name
- BLUE STREAM HOSPICE AND PALLIATIVE CARE INC
- Incorporation date
- 2020-08-28
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2646 S LOOP W
- Address line 2
- STE 635
- City
- HOUSTON
- State
- TX
- Zip code
- 770542795