- Enrollment id
- O20240809000479
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1174208490
- Multiple npi flag
- N
- Ccn
- 758105
- Associate id
- 5496117533
- Organization name
- PHOENIX HOME HEALTH TORRANCE, LLC
- Doing business as name
- PHOENIX HOME HEALTH
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 21151 S WESTERN AVE
- Address line 2
- STE 154
- City
- TORRANCE
- State
- CA
- Zip code
- 905011724