- Enrollment id
- O20090126000157
- Enrollment state
- AL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1093966095
- Multiple npi flag
- N
- Ccn
- 017170
- Associate id
- 6305832502
- Organization name
- MID-SOUTH HOME HEALTH, LLC
- Doing business as name
- CENTERWELL HOME HEALTH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1458 JONES DAIRY RD
- Address line 2
- STE 100
- City
- JASPER
- State
- AL
- Zip code
- 355016111