- Enrollment id
- O20210506000022
- Enrollment state
- ID
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1861082588
- Multiple npi flag
- N
- Ccn
- 137049
- Associate id
- 5597174425
- Organization name
- BLUEBIRD HOME HEALTH, LLC
- Incorporation date
- 2021-01-21
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3080 E GENTRY WAY
- Address line 2
- STE 203
- City
- MERIDIAN
- State
- ID
- Zip code
- 836423013