- Enrollment id
- O20210923000135
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1023611092
- Multiple npi flag
- N
- Ccn
- 559669
- Associate id
- 1951708650
- Organization name
- CLOVER HOME HEALTH CARE INC
- Incorporation date
- 2020-05-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 512 E WILSON AVE
- Address line 2
- STE 306
- City
- GLENDALE
- State
- CA
- Zip code
- 912064351