- Enrollment id
- O20240530000878
- Enrollment state
- MO
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1891568168
- Multiple npi flag
- N
- Ccn
- 267684
- Associate id
- 0244672665
- Organization name
- DOVER HOME HEALTH MO STL METRO LLC
- Incorporation date
- 2023-10-23
- Incorporation state
- MO
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 300 HUNTER AVE
- Address line 2
- STE 107
- City
- SAINT LOUIS
- State
- MO
- Zip code
- 631242081