- Enrollment id
- O20250326000544
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1225797558
- Multiple npi flag
- N
- Ccn
- 758012
- Associate id
- 6204373707
- Organization name
- CARE SOURCE HOME HEALTH CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 9017 RESEDA BLVD
- Address line 2
- STE 205
- City
- NORTHRIDGE
- State
- CA
- Zip code
- 913243984
- Practice location type
- HHA BRANCH