- Enrollment id
- O20030415000004
- Enrollment state
- MO
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1386630036
- Multiple npi flag
- N
- Ccn
- 267582
- Associate id
- 9537078456
- Organization name
- MED-STAFF HOME HEALTH, LLC
- Incorporation date
- 2003-02-18
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 301 SOVEREIGN CT
- Address line 2
- STE 209
- City
- BALLWIN
- State
- MO
- Zip code
- 630114435