- Enrollment id
- O20230821000993
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1053064493
- Multiple npi flag
- N
- Ccn
- 757577
- Associate id
- 8628430899
- Organization name
- LILY HOME HEALTH SERVICES
- Incorporation date
- 2021-10-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE B180C
- City
- GLENDALE
- State
- CA
- Zip code
- 912032230