- Enrollment id
- O20100831000289
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1790006195
- Multiple npi flag
- N
- Ccn
- 368397
- Associate id
- 8729102587
- Organization name
- LIBERTY HOME HEALTH CARE OF OHIO, LLC
- Incorporation date
- 2010-06-14
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6161 BUSCH BLVD
- Address line 2
- SUITE 203
- City
- COLUMBUS
- State
- OH
- Zip code
- 432292548