- Enrollment id
- O20220628001538
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1124603881
- Multiple npi flag
- N
- Ccn
- 757302
- Associate id
- 0941689582
- Organization name
- LAKEVIEW HOME HEALTH CARE
- Incorporation date
- 2021-02-17
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 21405 DEVONSHIRE ST
- Address line 2
- STE 206
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913112939