- Enrollment id
- O20210830000125
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164020780
- Multiple npi flag
- N
- Ccn
- 559668
- Associate id
- 4082019013
- Organization name
- FIRST RELIABLE HOME CARE INC
- Incorporation date
- 2020-09-28
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 16501 SHERMAN WAY
- Address line 2
- STE 105
- City
- VAN NUYS
- State
- CA
- Zip code
- 914063757