- Enrollment id
- O20080425000209
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1033391750
- Multiple npi flag
- N
- Ccn
- 148056
- Associate id
- 9234217613
- Organization name
- OPEN WATERS HOME HEALTH CARE, INC.
- Incorporation date
- 2007-03-01
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5940 W TOUHY AVENUE
- Address line 2
- SUITE 145
- City
- NILES
- State
- IL
- Zip code
- 607144638