- Enrollment id
- O20050105000271
- Enrollment state
- NY
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1760414171
- Multiple npi flag
- N
- Ccn
- 337289
- Associate id
- 3678481660
- Organization name
- QC-MEDI NEW YORK, INC.
- Doing business as name
- CENTERWELL HOME HEALTH
- Incorporation date
- 1985-07-18
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 865 MERRICK AVE
- Address line 2
- SUITE 340 SOUTH
- City
- WESTBURY
- State
- NY
- Zip code
- 115906695