- Enrollment id
- O20221221000504
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1205404068
- Multiple npi flag
- N
- Ccn
- 757481
- Associate id
- 2264802974
- Organization name
- PRIMA CARE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2500 E FOOTHILL BLVD
- Address line 2
- STE 508
- City
- PASADENA
- State
- CA
- Zip code
- 911073473
- Practice location type
- HHA BRANCH