- Enrollment id
- O20051118000195
- Enrollment state
- RI
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1841413994
- Multiple npi flag
- N
- Ccn
- 417051
- Associate id
- 2567481518
- Organization name
- HOMECARE ADVANTAGE CHC INC.
- Incorporation date
- 1997-06-09
- Incorporation state
- RI
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 165 BURNSIDE STREET
- City
- CRANSTON
- State
- RI
- Zip code
- 029101149