- Enrollment id
- O20030617000001
- Enrollment state
- NY
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1396836219
- Multiple npi flag
- N
- Ccn
- 337414
- Associate id
- 5092625152
- Organization name
- EXTENDED NURSING PERSONNEL CHHA LLC
- Doing business as name
- EXTENDED HOME CARE
- Incorporation date
- 1996-06-01
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 7 PENN PLZ
- Address line 2
- STE 422
- City
- NEW YORK
- State
- NY
- Zip code
- 100010022