- Enrollment id
- O20190826000541
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1245727783
- Multiple npi flag
- N
- Ccn
- 559574
- Associate id
- 9335477660
- Organization name
- AVICENNA HOME HEALTH, INC.
- Incorporation date
- 2017-11-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17915 VENTURA BLVD
- Address line 2
- STE 222
- City
- ENCINO
- State
- CA
- Zip code
- 913164811