- Enrollment id
- O20200530000137
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1548501539
- Multiple npi flag
- N
- Ccn
- 369273
- Associate id
- 5092136028
- Organization name
- RENAISSANCE HEALTHCARE LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6422 E MAIN ST
- Address line 2
- STE 205
- City
- REYNOLDSBURG
- State
- OH
- Zip code
- 430682302