- Enrollment id
- O20200616002697
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1194361592
- Multiple npi flag
- N
- Ccn
- 053101
- Associate id
- 5799107983
- Organization name
- GUARDIAN ANGEL HOME CARE OF SANTA ROSA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 100 STONY POINT RD
- Address line 2
- STE 265
- City
- SANTA ROSA
- State
- CA
- Zip code
- 954014155