- Enrollment id
- O20201215001151
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1235785858
- Multiple npi flag
- N
- Ccn
- 559482
- Associate id
- 0345652467
- Organization name
- VIDACARE
- Incorporation date
- 2019-06-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 13701 RIVERSIDE DR
- Address line 2
- STE 705
- City
- SHERMAN OAKS
- State
- CA
- Zip code
- 914232449