- Enrollment id
- O20070212000723
- Enrollment state
- HI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1811045594
- Multiple npi flag
- N
- Ccn
- 121508
- Associate id
- 2769484203
- Organization name
- BRISTOL HOSPICE - HAWAII, L.L.C.
- Incorporation date
- 2007-08-10
- Incorporation state
- UT
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 55 MERCHANT ST
- Address line 2
- STE 2900
- City
- HONOLULU
- State
- HI
- Zip code
- 968134384