- Enrollment id
- O20080618000797
- Enrollment state
- MN
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1609048883
- Multiple npi flag
- N
- Ccn
- 241589
- Associate id
- 3971674961
- Organization name
- PRESBYTERIAN HOMES HOSPICE INC
- Doing business as name
- OPTAGE HOSPICE
- Incorporation date
- 2007-08-21
- Incorporation state
- MN
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 2845 HAMLINE N AVE
- City
- ROSEVILLE
- State
- MN
- Zip code
- 551137127