- Enrollment id
- O20210202002321
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1265038863
- Multiple npi flag
- N
- Ccn
- 753134
- Associate id
- 6406260447
- Organization name
- INFLUENTIAL HOME HEALTH INC
- Incorporation date
- 2020-11-23
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 19634 VENTURA BLVD
- Address line 2
- STE 215
- City
- TARZANA
- State
- CA
- Zip code
- 913567139