- Enrollment id
- O20221115000210
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1245955541
- Multiple npi flag
- N
- Ccn
- 757998
- Associate id
- 0446628960
- Organization name
- MEDWAVE HOME HEALTH INC
- Incorporation date
- 2022-07-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1864 E WASHINGTON BLVD
- Address line 2
- STE 205
- City
- PASADENA
- State
- CA
- Zip code
- 911041667