- Enrollment id
- O20100330000186
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164470191
- Multiple npi flag
- N
- Ccn
- 147293
- Associate id
- 0446140180
- Organization name
- MCDONOUGH COUNTY HOSPITAL DISTRICT
- Doing business as name
- MCDONOUGH DISTRICT HOSPITAL HOME HEALTH
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Address line 1
- 525 E GRANT ST
- City
- MACOMB
- State
- IL
- Zip code
- 614553313