- Enrollment id
- O20200403001779
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1750854451
- Multiple npi flag
- N
- Ccn
- 297270
- Associate id
- 4880023357
- Organization name
- MOBILE HOME HEALTH INC
- Incorporation date
- 2017-08-06
- Incorporation state
- NV
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1771 E FLAMINGO RD
- Address line 2
- STE 230A
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891190851