- Enrollment id
- O20160321002200
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1578933149
- Multiple npi flag
- N
- Ccn
- 053108
- Associate id
- 5395042246
- Organization name
- PROFESSIONAL HEALTHCARE GROUP INC
- Doing business as name
- PRO HOME HEALTH
- Incorporation date
- 2015-09-17
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5100 N 6TH ST
- Address line 2
- STE 155
- City
- FRESNO
- State
- CA
- Zip code
- 937107516
- Practice location type
- HHA BRANCH