- Enrollment id
- O20201228001800
- Enrollment state
- MN
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1477169233
- Multiple npi flag
- N
- Ccn
- 247078
- Associate id
- 7012320625
- Organization name
- ACCENTCARE FAIRVIEW HOME HEALTH - WEST, LLC
- Incorporation date
- 2020-06-22
- Incorporation state
- MN
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 767 EUSTIS ST
- Address line 2
- STE 150
- City
- SAINT PAUL
- State
- MN
- Zip code
- 551140018