- Enrollment id
- O20040218000929
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1083609853
- Multiple npi flag
- N
- Ccn
- 058063
- Associate id
- 1951296987
- Organization name
- PRIORITY ONE HOME HEALTH SERVICES INC
- Incorporation date
- 2000-06-08
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 108C
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632358