- Enrollment id
- O20220222000031
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1275209652
- Multiple npi flag
- N
- Ccn
- 757294
- Associate id
- 0941694764
- Organization name
- PLATINUM WELLNESS HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5121 VAN NUYS BLVD
- Address line 2
- STE 222
- City
- SHERMAN OAKS
- State
- CA
- Zip code
- 914036123
- Practice location type
- HHA BRANCH