- Enrollment id
- O20050329000891
- Enrollment state
- NE
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1790771301
- Multiple npi flag
- N
- Ccn
- 281513
- Associate id
- 7416901707
- Organization name
- DELMAR GARDENS OF OMAHA, LLC
- Doing business as name
- ST. JOSEPH VILLA HOMECARE & HOSPICE
- Incorporation date
- 2003-03-12
- Incorporation state
- NE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 825 DORCAS ST
- City
- OMAHA
- State
- NE
- Zip code
- 681081160