- Enrollment id
- O20070221000638
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1235295361
- Multiple npi flag
- N
- Ccn
- 059035
- Associate id
- 7416059407
- Organization name
- CENTRAL HOME HEALTH AGENCY
- Incorporation date
- 2006-11-16
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 220 S KENWOOD ST
- Address line 2
- STE 330
- City
- GLENDALE
- State
- CA
- Zip code
- 912051613