- Enrollment id
- O20160309001359
- Enrollment state
- AZ
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1851792808
- Multiple npi flag
- N
- Ccn
- 037469
- Associate id
- 0941506422
- Organization name
- GRAND CANYON HOME HEALTH CARE INC
- Incorporation date
- 2014-09-30
- Incorporation state
- AZ
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2432 W PEORIA AVE
- Address line 2
- STE 1073B
- City
- PHOENIX
- State
- AZ
- Zip code
- 850294730