- Enrollment id
- O20100309000620
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1801125539
- Multiple npi flag
- N
- Ccn
- 148269
- Associate id
- 2365587789
- Organization name
- PLATINUM HEALTHCARE SERVICES, LLC
- Doing business as name
- PLATINUM HEALTHCARE SERVICES
- Incorporation date
- 2008-09-19
- Incorporation state
- IL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1420 RENAISSANCE DR
- Address line 2
- STE 207
- City
- PARK RIDGE
- State
- IL
- Zip code
- 600681342
- Practice location type
- HHA BRANCH