- Enrollment id
- O20221115002255
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1174275861
- Multiple npi flag
- N
- Ccn
- 757813
- Associate id
- 0648648113
- Organization name
- WELL CENTRE HOME HEALTH CARE, INC
- Incorporation date
- 2021-06-21
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 815 S CENTRAL AVE
- Address line 2
- STE 24
- City
- GLENDALE
- State
- CA
- Zip code
- 912042092