- Enrollment id
- O20080604000272
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1982607123
- Multiple npi flag
- N
- Ccn
- 147003
- Associate id
- 8527069715
- Organization name
- MEMORIAL HOME SERVICES
- Incorporation date
- 1916-02-21
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 701 NORTH FIRST STREET, MAILBOX 15
- City
- SPRINGFIELD
- State
- IL
- Zip code
- 62781