- Enrollment id
- O20150817002976
- Enrollment state
- NM
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1992182422
- Multiple npi flag
- N
- Ccn
- 321572
- Associate id
- 8325353501
- Organization name
- HIGH DESERT HOSPICE LLC
- Incorporation date
- 2015-04-15
- Incorporation state
- NM
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 8661 SAN PEDRO DR NE
- City
- ALBUQUERQUE
- State
- NM
- Zip code
- 871131942