- Enrollment id
- O20241219000191
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1164108478
- Multiple npi flag
- N
- Ccn
- 757885
- Associate id
- 2668909359
- Organization name
- PREMIER CARE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12501 CHANDLER BLVD
- Address line 2
- 101-2
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916071941