- Enrollment id
- O20191021000365
- Enrollment state
- AZ
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1811549488
- Multiple npi flag
- N
- Ccn
- 031703
- Associate id
- 5092046268
- Organization name
- GOLDEN CARE HOSPICE LLC
- Incorporation state
- AZ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2432 W PEORIA AVE
- Address line 2
- STE 1073A
- City
- PHOENIX
- State
- AZ
- Zip code
- 85029