- Enrollment id
- O20070803000495
- Enrollment state
- WV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1184848970
- Multiple npi flag
- N
- Ccn
- 517097
- Associate id
- 1658462791
- Organization name
- BOONE MEMORIAL HOMECARE, LLC
- Doing business as name
- BOONE MEMORIAL HOMECARE
- Incorporation date
- 2007-03-30
- Incorporation state
- WV
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 298 TRICORN RD
- City
- DANVILLE
- State
- WV
- Zip code
- 250537148