- Enrollment id
- O20230412001321
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1215690938
- Multiple npi flag
- N
- Ccn
- 757608
- Associate id
- 1456726090
- Organization name
- FAST DOC HOME HEALTH, INC.
- Incorporation date
- 2021-01-07
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1314 W GLENOAKS BLVD
- Address line 2
- STE 101-A
- City
- GLENDALE
- State
- CA
- Zip code
- 912011978