- Enrollment id
- O20210610002925
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1114441300
- Multiple npi flag
- N
- Ccn
- 559576
- Associate id
- 1456751551
- Organization name
- WELLNESS HEALTHCARE INC
- Incorporation date
- 2017-07-19
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12444 VICTORY BLVD
- Address line 2
- STE 102
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916063156