- Enrollment id
- O20190425002039
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1063926830
- Multiple npi flag
- N
- Ccn
- 559039
- Associate id
- 9537401484
- Organization name
- MMA HOME HEALTH CARE, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3800 W BURBANK BLVD
- Address line 2
- STE 105
- City
- BURBANK
- State
- CA
- Zip code
- 915052148