- Enrollment id
- O20231214002187
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1104406917
- Multiple npi flag
- N
- Ccn
- 758015
- Associate id
- 1456700533
- Organization name
- BLOOM HOME HEALTH CARE INC
- Incorporation date
- 2022-05-10
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 22151 VENTURA BLVD
- Address line 2
- STE 204B
- City
- WOODLAND HILLS
- State
- CA
- Zip code
- 913641666