- Enrollment id
- O20151120001937
- Enrollment state
- KS
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1629456223
- Multiple npi flag
- N
- Ccn
- 178061
- Associate id
- 6709186893
- Organization name
- HEALTH WATCH HEALTH CARE OF LIBERAL LLC
- Incorporation date
- 2015-02-25
- Incorporation state
- OK
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1701 N KANSAS AVE
- Address line 2
- STE 106
- City
- LIBERAL
- State
- KS
- Zip code
- 679012000