- Enrollment id
- O20191107000188
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164984589
- Multiple npi flag
- N
- Ccn
- 369267
- Associate id
- 2769814078
- Organization name
- HEALTHCARESTAR HOME HEALTH LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2101 S HAMILTON RD
- Address line 2
- STE 214
- City
- COLUMBUS
- State
- OH
- Zip code
- 432324144