- Enrollment id
- O20250217003309
- Enrollment state
- IL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1811745730
- Multiple npi flag
- N
- Ccn
- 141705
- Associate id
- 9032639356
- Organization name
- DOVER HOSPICE IL CHICAGO METRO, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3333 75TH ST
- Address line 2
- LL20-A
- City
- WOODRIDGE
- State
- IL
- Zip code
- 605172730