- Enrollment id
- O20040504001246
- Enrollment state
- PA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1518901610
- Multiple npi flag
- N
- Ccn
- 397472
- Associate id
- 2365430766
- Organization name
- SOUTHEASTERN HEALTH SERVICES OF PENNSYLVANIA, LLC
- Doing business as name
- ACCENTCARE HEALTH OF PENNSYLVANIA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1501 GRUNDY LN 100
- City
- BRISTOL
- State
- PA
- Zip code
- 190071506