- Enrollment id
- O20240401002218
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1033840756
- Multiple npi flag
- N
- Ccn
- 758147
- Associate id
- 2062877707
- Organization name
- WHITE LIGHT HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1241 S GLENDALE AVE
- Address line 2
- STE 304A
- City
- GLENDALE
- State
- CA
- Zip code
- 912053386