- Enrollment id
- O20191213000130
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1104385582
- Multiple npi flag
- N
- Ccn
- 559267
- Associate id
- 6103259601
- Organization name
- OAK VIEW HHA LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1100 E BROADWAY
- Address line 2
- STE 305
- City
- GLENDALE
- State
- CA
- Zip code
- 912054641