- Enrollment id
- O20200527000023
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1023653011
- Multiple npi flag
- N
- Ccn
- 059778
- Associate id
- 9234550476
- Organization name
- GUARDIAN ANGEL HOME CARE OF SAN JOSE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1885 THE ALAMEDA
- Address line 2
- STE 208
- City
- SAN JOSE
- State
- CA
- Zip code
- 951261747