- Enrollment id
- O20030808000000
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1700876950
- Multiple npi flag
- N
- Ccn
- 147749
- Associate id
- 2264343847
- Organization name
- GOLD HEALTH HOME CARE CORP
- Incorporation date
- 2003-03-05
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2720 S RIVER RD
- Address line 2
- STE 130
- City
- DES PLAINES
- State
- IL
- Zip code
- 600184110