- Enrollment id
- O20210616002487
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1063097285
- Multiple npi flag
- N
- Ccn
- 559608
- Associate id
- 8921408642
- Organization name
- AVAN HOME HEALTH CARE INC
- Incorporation date
- 2020-08-25
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 19231 VICTORY BLVD
- Address line 2
- STE 109
- City
- RESEDA
- State
- CA
- Zip code
- 913356320