- Enrollment id
- O20210520001924
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1306421417
- Multiple npi flag
- N
- Ccn
- 369310
- Associate id
- 2062811201
- Organization name
- CUSTOMIZED HOME HEALTH CARE LLC
- Incorporation date
- 2020-12-25
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6161 BUSCH BLVD
- Address line 2
- STE 126
- City
- COLUMBUS
- State
- OH
- Zip code
- 432292553
- Practice location type
- HHA BRANCH