- Enrollment id
- O20071128000588
- Enrollment state
- MD
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164606406
- Multiple npi flag
- N
- Ccn
- 217036
- Associate id
- 1850480856
- Organization name
- PHR OF BALTIMORE, INC.
- Incorporation date
- 2006-06-26
- Incorporation state
- VA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1501 S EDGEWOOD ST
- Address line 2
- STE A
- City
- BALTIMORE
- State
- MD
- Zip code
- 212271071