- Enrollment id
- O20201224000027
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1134729437
- Multiple npi flag
- N
- Ccn
- 753185
- Associate id
- 4385056944
- Organization name
- MISSION HOME CARE SERVICES INC
- Incorporation date
- 2020-07-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 512 E WILSON AVE
- Address line 2
- STE 402
- City
- GLENDALE
- State
- CA
- Zip code
- 912064351