- Enrollment id
- O20210419000274
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164015061
- Multiple npi flag
- N
- Ccn
- 369331
- Associate id
- 3476961145
- Organization name
- GOLD CROWN HOME HEALTH CARE LLC
- Incorporation date
- 2019-04-12
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1425 EAST DUBLIN-GRANVILLE ROAD
- Address line 2
- SUITE 205
- City
- COLUMBUS
- State
- OH
- Zip code
- 432293312