- Enrollment id
- O20181012000888
- Enrollment state
- NE
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1619456696
- Multiple npi flag
- N
- Ccn
- 287016
- Associate id
- 7911258520
- Organization name
- METHODIST FREMONT HEALTH
- Doing business as name
- METHODIST FREMONT HEALTH HOME CARE
- Incorporation date
- 2018-06-29
- Incorporation state
- NE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 450 E 23RD ST
- Address line 2
- STE 2224
- City
- FREMONT
- State
- NE
- Zip code
- 680252303