- Enrollment id
- O20101011000819
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1063726628
- Multiple npi flag
- N
- Ccn
- 557711
- Associate id
- 2567654460
- Organization name
- MISSION HOME HEALTH OF SAN DIEGO LLC
- Incorporation date
- 2009-06-30
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2365 NORTHSIDE DR
- Address line 2
- STE 100
- City
- SAN DIEGO
- State
- CA
- Zip code
- 921082710