- Enrollment id
- O20060801000358
- Enrollment state
- MA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1205869575
- Multiple npi flag
- N
- Ccn
- 227509
- Associate id
- 0648283002
- Organization name
- PRIMARY HOMECARE SPECIALTIES, LLC
- Incorporation date
- 2005-11-15
- Incorporation state
- MA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 75 ADAMS ST SUITE D
- City
- MILTON
- State
- MA
- Zip code
- 021863441