- Enrollment id
- O20150625002711
- Enrollment state
- GA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1528485364
- Multiple npi flag
- N
- Ccn
- 111768
- Associate id
- 7517278989
- Organization name
- PRECIOUS HOSPICE LLC
- Incorporation date
- 2014-02-14
- Incorporation state
- GA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 105 HABERSHAM DR SUITE D
- City
- FAYETTEVILLE
- State
- GA
- Zip code
- 30214