- Enrollment id
- O20200917003263
- Enrollment state
- MS
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1699397299
- Multiple npi flag
- N
- Ccn
- 251709
- Associate id
- 2062830326
- Organization name
- SHEPHERD HOSPICE LLC
- Incorporation date
- 2020-05-01
- Incorporation state
- MS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 106 W BANKHEAD ST
- City
- NEW ALBANY
- State
- MS
- Zip code
- 386523313