- Enrollment id
- O20100429000842
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295063063
- Multiple npi flag
- N
- Ccn
- 368388
- Associate id
- 9133256753
- Organization name
- HOME CARE VILLAGE, LLC
- Incorporation date
- 2009-12-03
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1495 MORSE RD
- Address line 2
- STE 108
- City
- COLUMBUS
- State
- OH
- Zip code
- 432296434