- Enrollment id
- O20200625003226
- Enrollment state
- WI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1912531997
- Multiple npi flag
- N
- Ccn
- 521605
- Associate id
- 0345662052
- Organization name
- MOMENTS HOSPICE OF MILWAUKEE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1139 S SUNNYSLOPE DR
- Address line 2
- STE 200
- City
- MT PLEASANT
- State
- WI
- Zip code
- 534063998