- Enrollment id
- O20220712002323
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1306429105
- Multiple npi flag
- N
- Ccn
- 369383
- Associate id
- 5890175566
- Organization name
- CRESCENT HOME CARE LLC
- Incorporation date
- 2021-04-22
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6161 BUSCH BLVD
- Address line 2
- STE 304
- City
- COLUMBUS
- State
- OH
- Zip code
- 432292555