- Enrollment id
- O20200518001803
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1144790676
- Multiple npi flag
- N
- Ccn
- 758039
- Associate id
- 5597196097
- Organization name
- AVALON HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 16430 VENTURA BLVD
- Address line 2
- STE 202B
- City
- ENCINO
- State
- CA
- Zip code
- 914362136