- Enrollment id
- O20090113000204
- Enrollment state
- MS
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1356482749
- Multiple npi flag
- N
- Ccn
- 257102
- Associate id
- 7214028661
- Organization name
- STA-HOME HEALTH AGENCY OF JACKSON, INC.
- Doing business as name
- ACCENTCARE HOME HEALTH OF JACKSON
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 130 FAIRMONT ST
- Address line 2
- STE A
- City
- CLINTON
- State
- MS
- Zip code
- 390564714