- Enrollment id
- O20241227002678
- Enrollment state
- CO
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164204830
- Multiple npi flag
- N
- Ccn
- 067647
- Associate id
- 2567999881
- Organization name
- PRIME CARE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2121 S ONEIDA ST
- Address line 2
- STE 100
- City
- DENVER
- State
- CO
- Zip code
- 802242550