- Enrollment id
- O20130730000275
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1861733263
- Multiple npi flag
- N
- Ccn
- 369120
- Associate id
- 7517108822
- Organization name
- HOLISTIC LIFE HOME HEALTH CARE LLC
- Incorporation date
- 2013-01-14
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2101 S HAMILTON ROAD
- Address line 2
- STE 102
- City
- COLUMBUS
- State
- OH
- Zip code
- 432324144