- Enrollment id
- O20171006002815
- Enrollment state
- AZ
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1972999100
- Multiple npi flag
- N
- Ccn
- 037476
- Associate id
- 4880969468
- Organization name
- COPPER STATE HOME HEALTH, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 996 N BROAD ST
- Address line 2
- STE 7
- City
- GLOBE
- State
- AZ
- Zip code
- 855012300
- Practice location type
- HHA BRANCH