- Enrollment id
- O20170130001010
- Enrollment state
- PA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1649623232
- Multiple npi flag
- N
- Ccn
- 398277
- Associate id
- 7214219187
- Organization name
- FAMILY CARE HOME HEALTH LLC
- Incorporation date
- 2016-07-05
- Incorporation state
- PA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 212 W 5TH ST
- City
- BLOOMSBURG
- State
- PA
- Zip code
- 178152107