- Enrollment id
- O20090223000622
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1174769707
- Multiple npi flag
- N
- Ccn
- 368274
- Associate id
- 5294890489
- Organization name
- PACIFIC HOME HEALTH SERVICES, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2999 EAST DUBLIN GRANVILLE RD
- Address line 2
- SUITE 300
- City
- COLUMBUS
- State
- OH
- Zip code
- 43231