- Enrollment id
- O20180621002286
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1659881761
- Multiple npi flag
- N
- Ccn
- 971502
- Associate id
- 4082969621
- Organization name
- SHALEM HOSPICE CARE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2611 N BELT LINE RD
- Address line 2
- STE 127A
- City
- SUNNYVALE
- State
- TX
- Zip code
- 751829356