- Enrollment id
- O20230828000665
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1225792328
- Multiple npi flag
- N
- Ccn
- 757989
- Associate id
- 4284097098
- Organization name
- HOMEBRIDGE HEALTH CARE
- Incorporation date
- 2021-09-28
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 399-1
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112397