- Enrollment id
- O20050317000291
- Enrollment state
- MO
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295728616
- Multiple npi flag
- N
- Ccn
- 267594
- Associate id
- 6709831274
- Organization name
- PATIENT CARE PROFESSIONALS INC
- Incorporation date
- 2005-02-09
- Incorporation state
- MO
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 301 SOVEREIGN CT
- Address line 2
- 102
- City
- BALLWIN
- State
- MO
- Zip code
- 630114435