- Enrollment id
- O20200826002040
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1437776374
- Multiple npi flag
- N
- Ccn
- 369254
- Associate id
- 4688091382
- Organization name
- ALTA HOME HEALTH CARE LLC
- Incorporation date
- 2020-06-23
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2586 TILLER LN
- Address line 2
- STE 2K
- City
- COLUMBUS
- State
- OH
- Zip code
- 432312265