- Enrollment id
- O20050726000351
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1790857001
- Multiple npi flag
- N
- Ccn
- 147841
- Associate id
- 6305873993
- Organization name
- ENTERA HEALTHCARE LTD.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 10700 W HIGGINS RD
- Address line 2
- STE 110
- City
- ROSEMONT
- State
- IL
- Zip code
- 600183726