- Enrollment id
- O20170424002052
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1932556750
- Multiple npi flag
- N
- Ccn
- 387164
- Associate id
- 6103102355
- Organization name
- DIVINE MERCY HOME HEALTH, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4900 SW GRIFFITH DR
- Address line 2
- STE 135
- City
- BEAVERTON
- State
- OR
- Zip code
- 970052977