- Enrollment id
- O20201204000054
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255946497
- Multiple npi flag
- N
- Ccn
- 369358
- Associate id
- 9739590258
- Organization name
- HIS GRACE HOME HEALTH CARE, LLC
- Incorporation date
- 2020-08-25
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1415 E DUBLIN GRANVILLE RD
- Address line 2
- STE 204
- City
- COLUMBUS
- State
- OH
- Zip code
- 432293311