- Enrollment id
- O20130613000252
- Enrollment state
- IL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1952641946
- Multiple npi flag
- N
- Ccn
- 141658
- Associate id
- 2365341211
- Organization name
- ST ANTHONYS MEMORIAL HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD
- Doing business as name
- HSHS HOSPICE ILLINOIS
- Incorporation date
- 1955-06-03
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 900 W TEMPLE AVE
- Address line 2
- STE 101
- City
- EFFINGHAM
- State
- IL
- Zip code
- 624012186