- Enrollment id
- O20201021002901
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1194383877
- Multiple npi flag
- N
- Ccn
- 757199
- Associate id
- 4183044639
- Organization name
- AMMA HEALTHCARE MANAGEMENT
- Incorporation date
- 2019-05-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 232 N LAKE AVE
- Address line 2
- STE 225
- City
- PASADENA
- State
- CA
- Zip code
- 911011862