- Enrollment id
- O20201014001081
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164037321
- Multiple npi flag
- N
- Ccn
- 757000
- Associate id
- 7214357177
- Organization name
- REJUVENATE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4119 W BURBANK BLVD
- Address line 2
- STE 184
- City
- BURBANK
- State
- CA
- Zip code
- 915052122