- Enrollment id
- O20200526001848
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1043855034
- Multiple npi flag
- N
- Ccn
- 368307
- Associate id
- 8921429143
- Organization name
- GUARDIAN ANGEL HOME CARE OF COLUMBUS
- Incorporation date
- 2019-10-24
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4889 SINCLAIR RD
- Address line 2
- STE 109
- City
- COLUMBUS
- State
- OH
- Zip code
- 432295433