- Enrollment id
- O20070705000095
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1841357126
- Multiple npi flag
- N
- Ccn
- 147985
- Associate id
- 4385744390
- Organization name
- ACACIA HOME HEALTH AGENCY
- Incorporation date
- 2005-09-10
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2200 S MAIN ST
- Address line 2
- STE 308
- City
- LOMBARD
- State
- IL
- Zip code
- 601485366