- Enrollment id
- O20250529004258
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1033830435
- Multiple npi flag
- N
- Ccn
- 758169
- Associate id
- 4284143546
- Organization name
- PROMED HOME HEALTH SERVICES, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17620 SHERMAN WAY
- Address line 2
- STE 203
- City
- VAN NUYS
- State
- CA
- Zip code
- 914063527