- Enrollment id
- O20180423001649
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1114430139
- Multiple npi flag
- N
- Ccn
- 559132
- Associate id
- 0345503546
- Organization name
- AVB & LV CORPORATION
- Doing business as name
- TEMPLE OF LIFE HOME CARE
- Incorporation date
- 2017-10-25
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 18340 VENTURA BLVD
- Address line 2
- STE 220
- City
- TARZANA
- State
- CA
- Zip code
- 913564269