- Enrollment id
- O20070131000619
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1003979543
- Multiple npi flag
- N
- Ccn
- 058458
- Associate id
- 4183626393
- Organization name
- VISITING ANGELS HOME HEALTH CARE, INC.
- Doing business as name
- MEDIA HOME HEALTH
- Incorporation date
- 2006-09-08
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- # 111
- City
- GLENDALE
- State
- CA
- Zip code
- 912051008
- Practice location type
- HHA BRANCH