- Enrollment id
- O20070126000229
- Enrollment state
- LA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1679642425
- Multiple npi flag
- N
- Ccn
- 191636
- Associate id
- 3779584297
- Organization name
- STILL WATERS HOSPICE, LLC
- Incorporation state
- LA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1405 METRO DR
- Address line 2
- STE L
- City
- ALEXANDRIA
- State
- LA
- Zip code
- 713013452