- Enrollment id
- O20041222000447
- Enrollment state
- MD
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1154437879
- Multiple npi flag
- N
- Ccn
- 217150
- Associate id
- 1951369990
- Organization name
- MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.
- Doing business as name
- MEDSTAR HEALTH HOME CARE
- Incorporation date
- 1900-04-16
- Incorporation state
- MD
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 6404 IVY LN
- Address line 2
- STE 110
- City
- GREENBELT
- State
- MD
- Zip code
- 207701416
- Practice location type
- HHA BRANCH