- Enrollment id
- O20180911001339
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1184116469
- Multiple npi flag
- N
- Ccn
- 559162
- Associate id
- 1759631898
- Organization name
- WELL CARE HOME HEALTH CARE INC
- Incorporation date
- 2018-05-18
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 13746 VICTORY BLVD
- Address line 2
- STE 313
- City
- VAN NUYS
- State
- CA
- Zip code
- 914016726