- Enrollment id
- O20190320000472
- Enrollment state
- MI
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1811461734
- Multiple npi flag
- N
- Ccn
- 237112
- Associate id
- 8820337504
- Organization name
- BEAUMONT ASHN LLC
- Doing business as name
- BEAUMONT HOME HEALTH
- Incorporation date
- 2018-11-09
- Incorporation state
- MI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1975 TECHNOLOGY DR
- Address line 2
- # J120
- City
- TROY
- State
- MI
- Zip code
- 480834247
- Practice location type
- HHA BRANCH