- Enrollment id
- O20250717001003
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295431005
- Multiple npi flag
- N
- Ccn
- 148443
- Associate id
- 1052826096
- Organization name
- MEDICUS HOME HEALTH LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9933 LAWLER AVE
- Address line 2
- STE 338A
- City
- SKOKIE
- State
- IL
- Zip code
- 600773773