- Enrollment id
- O20181121001825
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295268613
- Multiple npi flag
- N
- Ccn
- 559069
- Associate id
- 2961756325
- Organization name
- DAVIDA ENTERPRISES, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 10545 BURBANK BLVD
- Address line 2
- STE 116
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916012245