- Enrollment id
- O20120220000788
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1366447617
- Multiple npi flag
- N
- Ccn
- 147586
- Associate id
- 4385551258
- Organization name
- IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
- Doing business as name
- IROQUOIS HOME HEALTH
- Incorporation date
- 1921-10-04
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 200 E FAIRMAN AVE
- City
- WATSEKA
- State
- IL
- Zip code
- 609701644
- Practice location type
- HHA BRANCH