- Enrollment id
- O20210621000722
- Enrollment state
- OK
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1679182026
- Multiple npi flag
- N
- Ccn
- 371566
- Associate id
- 5991105413
- Organization name
- HERITAGE ACQUISITION, LLC.
- Doing business as name
- ACCENTRA HOSPICE - NORTHEASTERN
- Incorporation date
- 2020-01-31
- Incorporation state
- OK
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 114 S 4TH ST
- City
- HENRYETTA
- State
- OK
- Zip code
- 744375273