- Enrollment id
- O20250206002380
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164006094
- Multiple npi flag
- N
- Ccn
- 758064
- Associate id
- 9739527581
- Organization name
- BLOSSOM VALLEY HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 199-2
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112397
- Practice location type
- HHA BRANCH