- Enrollment id
- O20181107001544
- Enrollment state
- VA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1710473673
- Multiple npi flag
- N
- Ccn
- 497008
- Associate id
- 0749534907
- Organization name
- INOVA HOME HEALTH LLC
- Incorporation date
- 2018-04-20
- Incorporation state
- VA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9900 MAIN ST
- Address line 2
- STE 100
- City
- FAIRFAX
- State
- VA
- Zip code
- 220313920