- Enrollment id
- O20230628002258
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1275208670
- Multiple npi flag
- N
- Ccn
- 757478
- Associate id
- 1850759549
- Organization name
- LA CANADA HOME INC.
- Incorporation date
- 2021-07-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1545 N VERDUGO RD
- Address line 2
- STE 200
- City
- GLENDALE
- State
- CA
- Zip code
- 912082872