- Enrollment id
- O20050812000700
- Enrollment state
- NM
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1932125770
- Multiple npi flag
- N
- Ccn
- 321558
- Associate id
- 7911989223
- Organization name
- HERITAGE HOME HEALTHCARE & HOSPICE, INC
- Doing business as name
- GOOD SAMARITAN SOCIETY - HOSPICE
- Incorporation date
- 1999-07-01
- Incorporation state
- NM
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6700 JEFFERSON ST NE
- Address line 2
- SUITE D2
- City
- ALBUQUERQUE
- State
- NM
- Zip code
- 87109