- Enrollment id
- O20221215002690
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1770166449
- Multiple npi flag
- N
- Ccn
- 369319
- Associate id
- 0345659256
- Organization name
- FAITH HOME HEALTH AGENCY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2700 E DUBLIN GRANVILLE RD
- Address line 2
- STE 590
- City
- COLUMBUS
- State
- OH
- Zip code
- 432314034