- Enrollment id
- O20090902000495
- Enrollment state
- VA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1184879975
- Multiple npi flag
- Y
- Ccn
- 497656
- Associate id
- 4486709029
- Organization name
- PRO HEALTHCARE SERVICING,LLC
- Incorporation date
- 2008-11-01
- Incorporation state
- VA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 8315 LEE HWY 202
- City
- FAIRFAX
- State
- VA
- Zip code
- 220312215