- Enrollment id
- O20241223001714
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1194591230
- Multiple npi flag
- N
- Ccn
- 758003
- Associate id
- 5698202117
- Organization name
- BLUE DIAMOND HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 22024 LASSEN ST
- Address line 2
- STE 117
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913118327
- Practice location type
- HHA BRANCH