- Enrollment id
- O20130208000338
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1861749772
- Multiple npi flag
- N
- Ccn
- 369150
- Associate id
- 2860646320
- Organization name
- HOUSE OF HEAVEN HEALTH CARE LLC
- Incorporation date
- 2012-07-03
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6161 BUSCH BLVD
- Address line 2
- STE 122
- City
- COLUMBUS
- State
- OH
- Zip code
- 43229