- Enrollment id
- O20131115001423
- Enrollment state
- NC
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1861422990
- Multiple npi flag
- N
- Ccn
- 347106
- Associate id
- 8628204989
- Organization name
- WAKE FOREST BAPTIST HEALTH CARE AT HOME LLC
- Doing business as name
- ATRIUM HEALTH WAKE FOREST BAPTIST - CARE AT HOME
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2000 FRONTIS PLAZA BLVD
- Address line 2
- STE 303
- City
- WINSTON SALEM
- State
- NC
- Zip code
- 271035616