- Enrollment id
- O20210309003291
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1114519733
- Multiple npi flag
- N
- Ccn
- 757060
- Associate id
- 3072929454
- Organization name
- BOOST HOME HEALTH INC
- Incorporation date
- 2021-01-12
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 18747 SHERMAN WAY
- Address line 2
- STE 210
- City
- RESEDA
- State
- CA
- Zip code
- 913354000