- Enrollment id
- O20090326000129
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1225281520
- Multiple npi flag
- N
- Ccn
- 148073
- Associate id
- 7315004900
- Organization name
- CRYSTAL HOME HEALTH CARE, LLC
- Incorporation date
- 2006-04-06
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2720 S RIVER RD
- Address line 2
- STE 154
- City
- DES PLAINES
- State
- IL
- Zip code
- 600184152