- Enrollment id
- O20211027001509
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1205431251
- Multiple npi flag
- N
- Ccn
- 559773
- Associate id
- 7911395769
- Organization name
- ADVANTAGE HOME HEALTHCARE PROVIDER, INC
- Incorporation date
- 2020-11-12
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15545 DEVONSHIRE ST
- Address line 2
- STE 111
- City
- MISSION HILLS
- State
- CA
- Zip code
- 913452687
- Practice location type
- HHA BRANCH