- Enrollment id
- O20200716003569
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1629522776
- Multiple npi flag
- N
- Ccn
- 369266
- Associate id
- 2860816303
- Organization name
- THALIA HEALTHCARE LLC
- Incorporation date
- 2013-05-10
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1425 E DUBLIN GRANVILLE RD
- Address line 2
- STE 214
- City
- COLUMBUS
- State
- OH
- Zip code
- 432293312