- Enrollment id
- O20071127000314
- Enrollment state
- MO
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1265621700
- Multiple npi flag
- N
- Ccn
- 267612
- Associate id
- 1456449537
- Organization name
- FOUR ROSES LLC
- Doing business as name
- PREMIERE HOME HEALTH
- Incorporation date
- 2007-10-18
- Incorporation state
- MO
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 926 HEMSATH RD
- Address line 2
- STE 104A
- City
- SAINT CHARLES
- State
- MO
- Zip code
- 633036728
- Practice location type
- HHA BRANCH