- Enrollment id
- O20151230000380
- Enrollment state
- MI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1831509140
- Multiple npi flag
- N
- Ccn
- 231568
- Associate id
- 5698077105
- Organization name
- MICHIGAN COMMUNITY VNA HOSPICE LLC
- Doing business as name
- MICHIGAN COMMUNITY VNA HOSPICE
- Incorporation date
- 2014-05-06
- Incorporation state
- MI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 30800 TELEGRAPH RD
- Address line 2
- STE 1728
- City
- BINGHAM FARMS
- State
- MI
- Zip code
- 480255703