- Enrollment id
- O20230731002003
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1144989096
- Multiple npi flag
- N
- Ccn
- 757629
- Associate id
- 7214398767
- Organization name
- GREAT GRACE HOME INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 401 N BRAND BLVD
- Address line 2
- STE 834
- City
- GLENDALE
- State
- CA
- Zip code
- 912034451