- Enrollment id
- O20080725000569
- Enrollment state
- AR
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255380416
- Multiple npi flag
- N
- Ccn
- 047153
- Associate id
- 1658360284
- Organization name
- JOHNSON REGIONAL MEDICAL CENTER
- Doing business as name
- JOHNSON REGIONAL HOME CARE
- Incorporation date
- 1996-01-01
- Incorporation state
- AR
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 1100 E POPLAR ST
- Address line 2
- JOHNSON REGIONAL HOME CARE
- City
- CLARKSVILLE
- State
- AR
- Zip code
- 728304419