- Enrollment id
- O20200527000655
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1154882850
- Multiple npi flag
- N
- Ccn
- 559296
- Associate id
- 4486075645
- Organization name
- VITALITY HOME HEALTH CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 427 W COLORADO ST
- Address line 2
- STE 105
- City
- GLENDALE
- State
- CA
- Zip code
- 912043044