- Enrollment id
- O20160414001277
- Enrollment state
- OK
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1821057134
- Multiple npi flag
- N
- Ccn
- 371635
- Associate id
- 5991614992
- Organization name
- INTERIM HEALTHCARE OF OKLAHOMA CITY, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3613 NW 56TH ST
- Address line 2
- STE 385
- City
- OKLAHOMA CITY
- State
- OK
- Zip code
- 731124531