- Enrollment id
- O20171115001791
- Enrollment state
- MN
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1952484404
- Multiple npi flag
- N
- Ccn
- 241564
- Associate id
- 2062326820
- Organization name
- ST MARYS REGIONAL HEALTH CENTER
- Doing business as name
- ESSENTIA HEALTH HOSPICE WEST
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 900 HILLIGOSS BLVD SE
- City
- FOSSTON
- State
- MN
- Zip code
- 565421542