- Enrollment id
- O20240127000430
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1558997726
- Multiple npi flag
- Y
- Ccn
- 369381
- Associate id
- 0143673095
- Organization name
- PROCARE HOME HEALTH, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5900 ROCHE DR
- Address line 2
- STE 201
- City
- COLUMBUS
- State
- OH
- Zip code
- 432293290
- Practice location type
- HHA BRANCH