- Enrollment id
- O20200109001477
- Enrollment state
- IA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1750926481
- Multiple npi flag
- N
- Ccn
- 161612
- Associate id
- 4385079961
- Organization name
- MOMENTS HOSPICE OF DES MOINES LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1450 BOYSON RD
- Address line 2
- STE B3
- City
- HIAWATHA
- State
- IA
- Zip code
- 522332321