- Enrollment id
- O20070108000332
- Enrollment state
- PA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255302402
- Multiple npi flag
- N
- Ccn
- 397698
- Associate id
- 6406841295
- Organization name
- FULTON COUNTY MEDICAL CENTER
- Doing business as name
- TEAM HOME HEALTH
- Incorporation date
- 1947-08-18
- Incorporation state
- PA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 214 PEACH ORCHARD RD
- City
- MC CONNELLSBURG
- State
- PA
- Zip code
- 172338559