- Enrollment id
- O20090316000330
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1912158304
- Multiple npi flag
- N
- Ccn
- 368282
- Associate id
- 9335206572
- Organization name
- BOSCHULTE'S PRIDE II LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2242 S HAMILTON RD
- Address line 2
- STE 201
- City
- COLUMBUS
- State
- OH
- Zip code
- 432324300