- Enrollment id
- O20120920000390
- Enrollment state
- PR
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1932462991
- Multiple npi flag
- N
- Ccn
- 401572
- Associate id
- 6002064805
- Organization name
- HOSPICIO DIVINA MISERICORDIA, CORP.
- Incorporation date
- 2009-08-25
- Incorporation state
- PR
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 41 MUNOZ RIVERA AVENUE
- City
- VEGA ALTA
- State
- PR
- Zip code
- 006926533