- Enrollment id
- O20140220001566
- Enrollment state
- GA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1598191454
- Multiple npi flag
- N
- Ccn
- 111745
- Associate id
- 5698905545
- Organization name
- HOMESTEAD HOSPICE OF CENTRAL GEORGIA LLC
- Doing business as name
- TRADITIONS HEALTH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1744 WATSON BLVD
- Address line 2
- STE A&B
- City
- WARNER ROBINS
- State
- GA
- Zip code
- 310933632