- Enrollment id
- O20080320000172
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1285823799
- Multiple npi flag
- N
- Ccn
- 148019
- Associate id
- 8123104890
- Organization name
- FAMILY HOME HEALTH CARE PROFESSIONALS, INC.
- Incorporation date
- 2006-10-03
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3924 W DEVON AVE
- Address line 2
- STE 101C&D
- City
- LINCOLNWOOD
- State
- IL
- Zip code
- 607121040