- Enrollment id
- O20160420001520
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1881053643
- Multiple npi flag
- N
- Ccn
- 671786
- Associate id
- 0446558746
- Organization name
- ELYSIAN HOSPICE HOUSTON LLC
- Doing business as name
- ELYSIAN HOSPICE
- Incorporation date
- 2016-02-10
- Incorporation state
- TX
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 11104 W AIRPORT BLVD
- Address line 2
- STE 212B
- City
- STAFFORD
- State
- TX
- Zip code
- 774773197