- Enrollment id
- O20230330000089
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295486371
- Multiple npi flag
- N
- Ccn
- 757776
- Associate id
- 9436523685
- Organization name
- SAFE HAVEN HOME HEALTH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14531 HAMLIN ST
- Address line 2
- STE 275
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114126