- Enrollment id
- O20060609000097
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1740230622
- Multiple npi flag
- N
- Ccn
- 147901
- Associate id
- 9234141219
- Organization name
- CLASSIC HEALTH SERVICES, INC.
- Incorporation date
- 2005-10-19
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2200 S. MAIN ST
- Address line 2
- SUITE 300
- City
- LOMBARD
- State
- IL
- Zip code
- 601485364