- Enrollment id
- O20040113000609
- Enrollment state
- NY
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1548264088
- Multiple npi flag
- N
- Ccn
- 331544
- Associate id
- 1759281843
- Organization name
- GOOD SHEPHERD HOSPICE
- Incorporation date
- 1989-01-30
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 110 BI COUNTY BLVD
- Address line 2
- SUITE 114
- City
- FARMINGDALE
- State
- NY
- Zip code
- 117353923