- Enrollment id
- O20230323000181
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1215693221
- Multiple npi flag
- N
- Ccn
- 757334
- Associate id
- 8628442159
- Organization name
- VIVIDUS HOME CARE, INC
- Incorporation date
- 2021-09-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15643 SHERMAN WAY
- Address line 2
- STE 430
- City
- VAN NUYS
- State
- CA
- Zip code
- 914064185
- Practice location type
- HHA BRANCH