- Enrollment id
- O20081224000241
- Enrollment state
- FL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1588612857
- Multiple npi flag
- N
- Ccn
- 107643
- Associate id
- 0941362016
- Organization name
- FLORIDA HOME BOUND MENTAL HEALTH AGENCY INC.
- Incorporation date
- 1996-05-08
- Incorporation state
- FL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1400 NE 125TH STREET
- City
- NORTH MIAMI
- State
- FL
- Zip code
- 331616034