- Enrollment id
- O20180207002643
- Enrollment state
- FL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1679011720
- Multiple npi flag
- N
- Ccn
- 101558
- Associate id
- 2567722721
- Organization name
- BRISTOL HOSPICE - MIAMI DADE, LLC
- Incorporation date
- 2016-04-15
- Incorporation state
- UT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5201 BLUE LAGOON DR
- Address line 2
- STE 570
- City
- MIAMI
- State
- FL
- Zip code
- 331262075