- Enrollment id
- O20180821000000
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1134626245
- Multiple npi flag
- N
- Ccn
- 757667
- Associate id
- 4789933003
- Organization name
- MGD HOME HEALTH SERVICES INC
- Incorporation date
- 2018-02-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7200 VINELAND AVE
- Address line 2
- UNIT 218
- City
- SUN VALLEY
- State
- CA
- Zip code
- 913525088