- Enrollment id
- O20210615000204
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164004107
- Multiple npi flag
- N
- Ccn
- 757642
- Associate id
- 1355741224
- Organization name
- GLENDALE CARE HOME HEALTH
- Incorporation date
- 2021-04-03
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- STE 304C
- City
- GLENDALE
- State
- CA
- Zip code
- 912054099