- Enrollment id
- O20250109002804
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1063169241
- Multiple npi flag
- N
- Ccn
- 758154
- Associate id
- 2769910330
- Organization name
- WISE YEARS HOME HEALTH INC
- Doing business as name
- AVEDA HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 315 ARDEN AVE
- Address line 2
- STE 14
- City
- GLENDALE
- State
- CA
- Zip code
- 912031159