- Enrollment id
- O20110308000714
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1154625333
- Multiple npi flag
- N
- Ccn
- 368425
- Associate id
- 5698957900
- Organization name
- BLUE SHIELD HEALTH CARE SERVICES LLC
- Incorporation date
- 2010-12-21
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 4889 SINCLAIR RD
- Address line 2
- STE 207
- City
- COLUMBUS
- State
- OH
- Zip code
- 432295434
- Practice location type
- HHA BRANCH