- Enrollment id
- O20250828003269
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1184204026
- Multiple npi flag
- N
- Ccn
- 758171
- Associate id
- 1254832546
- Organization name
- HEALTHY MIND HOME CARE, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- STE 205C
- City
- GLENDALE
- State
- CA
- Zip code
- 912054096
- Practice location type
- HHA BRANCH