- Enrollment id
- O20201012001625
- Enrollment state
- CO
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1780298927
- Multiple npi flag
- N
- Ccn
- 061601
- Associate id
- 7810317955
- Organization name
- LHCG CLXIII, LLC
- Doing business as name
- AT HOME HOSPICE
- Incorporation date
- 2020-06-30
- Incorporation state
- CO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1325 S COLORADO BLVD
- Address line 2
- STE B-308
- City
- DENVER
- State
- CO
- Zip code
- 80022