- Enrollment id
- O20210930003143
- Enrollment state
- OH
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1710554647
- Multiple npi flag
- N
- Ccn
- 361672
- Associate id
- 9436556610
- Organization name
- HEALTH AT HOME HOSPICE- DAYTON LLC
- Doing business as name
- CARETENDERS HOSPICE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2621 DRYDEN RD
- Address line 2
- STE 204
- City
- MORAINE
- State
- OH
- Zip code
- 454391600