- Enrollment id
- O20070425000398
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1235344961
- Multiple npi flag
- N
- Ccn
- 059019
- Associate id
- 6305756891
- Organization name
- RAE STAR HEALTH SYSTEMS, INC.
- Incorporation date
- 2003-01-04
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17215 STUDEBAKER RD
- Address line 2
- STE 175
- City
- CERRITOS
- State
- CA
- Zip code
- 907032556