- Enrollment id
- O20120305000302
- Enrollment state
- AL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1558417386
- Multiple npi flag
- N
- Ccn
- 011538
- Associate id
- 5193700797
- Organization name
- CLAY COUNTY HEALTHCARE AUTHORITY
- Doing business as name
- HOSPICE OF CLAY COUNTY
- Incorporation date
- 1994-12-01
- Incorporation state
- AL
- Organization type structure
- OTHER
- Organization other type text
- HOSPICE
- Proprietary nonprofit
- P
- Address line 1
- 83825 HIGHWAY 9
- City
- ASHLAND
- State
- AL
- Zip code
- 362517981