- Enrollment id
- O20231109000753
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255007175
- Multiple npi flag
- N
- Ccn
- 757705
- Associate id
- 6103273388
- Organization name
- EVERLAST HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1545 N VERDUGO RD
- Address line 2
- STE 219
- City
- GLENDALE
- State
- CA
- Zip code
- 912083223