- Enrollment id
- O20050322000262
- Enrollment state
- MO
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1821025826
- Multiple npi flag
- N
- Ccn
- 261610
- Associate id
- 5698720720
- Organization name
- PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC
- Incorporation date
- 2004-10-12
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 301 SOVEREIGN CT
- Address line 2
- STE 206
- City
- BALLWIN
- State
- MO
- Zip code
- 630114435