- Enrollment id
- O20251119001191
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1710783931
- Multiple npi flag
- N
- Ccn
- 148442
- Associate id
- 1153812987
- Organization name
- ILLINOIS HOME HEALTH AGENCY LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1420 RENAISSANCE DR
- Address line 2
- STE 301F
- City
- PARK RIDGE
- State
- IL
- Zip code
- 600681345