- Enrollment id
- O20121009000533
- Enrollment state
- OR
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1871972224
- Multiple npi flag
- N
- Ccn
- 381563
- Associate id
- 9830350412
- Organization name
- CONNECTED HEALTHCARE, INC.
- Doing business as name
- SIGNATURE HEALTHCARE AT HOME
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7632 SW DURHAM RD
- Address line 2
- STE 130
- City
- TIGARD
- State
- OR
- Zip code
- 972247584