- Enrollment id
- O20140529000082
- Enrollment state
- WI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1841601952
- Multiple npi flag
- N
- Ccn
- 521599
- Associate id
- 2264596121
- Organization name
- ST CROIX HOSPICE LLC
- Doing business as name
- ST CROIX HOSPICE
- Incorporation date
- 2012-01-23
- Incorporation state
- MN
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1280 W CLAIREMONT AVE
- Address line 2
- STE 4
- City
- EAU CLAIRE
- State
- WI
- Zip code
- 547015212