- Enrollment id
- O20191127000754
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1154890069
- Multiple npi flag
- N
- Ccn
- 559154
- Associate id
- 4183057409
- Organization name
- WELLHEALTH LLC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1100 E BROADWAY
- Address line 2
- STE 307
- City
- GLENDALE
- State
- CA
- Zip code
- 912051384