- Enrollment id
- O20180523000429
- Enrollment state
- MN
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1518929934
- Multiple npi flag
- N
- Ccn
- 248045
- Associate id
- 2062326820
- Organization name
- ST MARYS REGIONAL HEALTH CENTER
- Doing business as name
- ESSENTIA HEALTH HOME CARE GRACEVILLE
- Incorporation date
- 1989-05-11
- Incorporation state
- MN
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 115 W 2ND ST
- City
- GRACEVILLE
- State
- MN
- Zip code
- 562404845