- Enrollment id
- O20220812003043
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1174192892
- Multiple npi flag
- N
- Ccn
- 557412
- Associate id
- 0547643272
- Organization name
- HOAG HOME HEALTH LLC
- Doing business as name
- HOAG HOME HEALTH
- Incorporation date
- 2020-12-10
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- N
- Address line 1
- 4041 MACARTHUR BLVD
- Address line 2
- STE 100
- City
- NEWPORT BEACH
- State
- CA
- Zip code
- 926602513