- Enrollment id
- O20050803000797
- Enrollment state
- MD
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1790899524
- Multiple npi flag
- N
- Ccn
- 217068
- Associate id
- 1951369990
- Organization name
- MEDSTAR HEALTH VISITING NURSE ASSOCIATION, INC.
- Doing business as name
- MEDSTAR HEALTH HOME CARE
- Incorporation date
- 1900-04-16
- Incorporation state
- DC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 5235 KING AVE
- Address line 2
- 4 TH FLOOR
- City
- BALTIMORE
- State
- MD
- Zip code
- 212374003
- Practice location type
- HHA BRANCH