- Enrollment id
- O20131217000858
- Enrollment state
- OH
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1942637673
- Multiple npi flag
- N
- Ccn
- 369084
- Associate id
- 2668609751
- Organization name
- LIFELINE HOMECARE SERVICES LLC
- Incorporation date
- 2013-08-09
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5979 E LIVINGSTON AVE
- Address line 2
- STE 100
- City
- COLUMBUS
- State
- OH
- Zip code
- 432322908