- Enrollment id
- O20180917000291
- Enrollment state
- AZ
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1982117305
- Multiple npi flag
- N
- Ccn
- 031693
- Associate id
- 2264783190
- Organization name
- LAVENDER HOSPICE LLC
- Doing business as name
- LAVENDER HOSPICE
- Incorporation date
- 2017-08-21
- Incorporation state
- AZ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 20815 N 25TH PL
- Address line 2
- STE A106
- City
- PHOENIX
- State
- AZ
- Zip code
- 850504617