- Enrollment id
- O20260312001728
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1104781640
- Multiple npi flag
- N
- Ccn
- 148344
- Associate id
- 8325521883
- Organization name
- WELLBOUND ILLINOIS LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1420 RENAISSANCE DR
- Address line 2
- STE 400
- City
- PARK RIDGE
- State
- IL
- Zip code
- 600681345