- Enrollment id
- O20070522000195
- Enrollment state
- WI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1861503534
- Multiple npi flag
- N
- Ccn
- 521505
- Associate id
- 4981590932
- Organization name
- AGRACE HOSPICECARE INCORPORATED
- Incorporation date
- 1978-10-19
- Incorporation state
- WI
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 5395 E CHERYL PKWY
- City
- FITCHBURG
- State
- WI
- Zip code
- 537115395