- Enrollment id
- O20230628004126
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1215657028
- Multiple npi flag
- N
- Ccn
- 369377
- Associate id
- 2365801099
- Organization name
- SUPERSTAR HOME HEALTHCARE, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1395 E DUBLIN GRANVILLE RD
- Address line 2
- STE 316
- City
- COLUMBUS
- State
- OH
- Zip code
- 432293314