- Enrollment id
- O20220921000104
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1144957945
- Multiple npi flag
- N
- Ccn
- 757787
- Associate id
- 7113302548
- Organization name
- HARVARD PRO HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE 503A
- City
- GLENDALE
- State
- CA
- Zip code
- 912032230