- Enrollment id
- O20150824002460
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255727178
- Multiple npi flag
- N
- Ccn
- 559622
- Associate id
- 4981910791
- Organization name
- ANGELIC HOME HEALTH CARE LLC
- Incorporation date
- 2015-01-29
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 22141 VENTURA BLVD
- Address line 2
- STE 209
- City
- WOODLAND HILLS
- State
- CA
- Zip code
- 913645724
- Practice location type
- HHA BRANCH