- Enrollment id
- O20230801001735
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1205588159
- Multiple npi flag
- N
- Ccn
- 757653
- Associate id
- 3072974518
- Organization name
- FORUM HEALTH SERVICES, INC.
- Incorporation date
- 2022-01-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12722 RIVERSIDE DR
- Address line 2
- STE 207A
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916073326