- Enrollment id
- O20230629002455
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1144989161
- Multiple npi flag
- N
- Ccn
- 757612
- Associate id
- 9335508944
- Organization name
- DIVINE PROVIDENCE HOME HEALTH CARE
- Incorporation date
- 2021-10-21
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 22151 VENTURA BLVD
- Address line 2
- STE 200A
- City
- WOODLAND HILLS
- State
- CA
- Zip code
- 913641666