- Enrollment id
- O20221130000064
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1003483322
- Multiple npi flag
- N
- Ccn
- 757590
- Associate id
- 3274901988
- Organization name
- AREV HOME HEALTH INC
- Incorporation date
- 2021-02-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 11565 LAUREL CANYON BLVD
- Address line 2
- STE 201
- City
- SAN FERNANDO
- State
- CA
- Zip code
- 913404651