- Enrollment id
- O20081105000315
- Enrollment state
- FL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1568041333
- Multiple npi flag
- Y
- Ccn
- 107628
- Associate id
- 9638238694
- Organization name
- BROOKS HOME CARE ADVANTAGE, INC.
- Doing business as name
- BROOKS REHABILITATION HOME HEALTH
- Incorporation date
- 2008-03-19
- Incorporation state
- FL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 1673 MASON AVE
- Address line 2
- STE 201
- City
- DAYTONA BEACH
- State
- FL
- Zip code
- 321175516