- Enrollment id
- O20100312000486
- Enrollment state
- IA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1710050661
- Multiple npi flag
- N
- Ccn
- 167146
- Associate id
- 0143131516
- Organization name
- BURGESS HEALTH CENTER
- Doing business as name
- BURGESS HOME HEALTH
- Incorporation date
- 1959-04-16
- Incorporation state
- IA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 1600 DIAMOND ST
- City
- ONAWA
- State
- IA
- Zip code
- 510401548