- Enrollment id
- O20240821000169
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1043074297
- Multiple npi flag
- N
- Ccn
- 369427
- Associate id
- 8123566221
- Organization name
- MESA HOME HEALTHCARE LLC
- Incorporation date
- 2024-02-06
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 733 E DUBLIN GRANVILLE RD
- Address line 2
- STE 20
- City
- COLUMBUS
- State
- OH
- Zip code
- 432293200
- Practice location type
- HHA BRANCH