- Enrollment id
- O20130718000132
- Enrollment state
- NY
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1518305572
- Multiple npi flag
- N
- Ccn
- 337450
- Associate id
- 4688815574
- Organization name
- WELLBOUND LLC
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 7424 13TH AVE
- City
- BROOKLYN
- State
- NY
- Zip code
- 112282021