- Enrollment id
- O20180314000013
- Enrollment state
- WA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1366962953
- Multiple npi flag
- N
- Ccn
- 507113
- Associate id
- 3779845656
- Organization name
- WENATCHEE HOME HEALTH LLC
- Doing business as name
- ADVANCED HOME HEALTH NW OF WENATCHEE
- Incorporation date
- 2016-10-25
- Incorporation state
- OR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 285 TECHNOLOGY CENTER WAY
- Address line 2
- STE 107
- City
- WENATCHEE
- State
- WA
- Zip code
- 988018120