- Enrollment id
- O20120215000280
- Enrollment state
- MN
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1386914588
- Multiple npi flag
- N
- Ccn
- 248132
- Associate id
- 7810061447
- Organization name
- SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE
- Doing business as name
- SHOLOM HOME CARE
- Incorporation date
- 2001-11-01
- Incorporation state
- MN
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 740 KAY AVE
- City
- SAINT PAUL
- State
- MN
- Zip code
- 551026014