- Enrollment id
- O20230925002392
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1093391294
- Multiple npi flag
- N
- Ccn
- 757698
- Associate id
- 8921452913
- Organization name
- MARYS HOME HEALTH CARE, INC
- Incorporation date
- 2021-02-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 127 S BRAND BLVD
- Address line 2
- STE 210
- City
- GLENDALE
- State
- CA
- Zip code
- 912041372