- Enrollment id
- O20190912000743
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295239028
- Multiple npi flag
- N
- Ccn
- 559207
- Associate id
- 9133458458
- Organization name
- PURE CARE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- STE 305E
- City
- GLENDALE
- State
- CA
- Zip code
- 912055514