- Enrollment id
- O20220622001183
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1306457817
- Multiple npi flag
- N
- Ccn
- 757088
- Associate id
- 6204215296
- Organization name
- INDIGO HOME HEALTH CARE, INC.
- Incorporation date
- 2020-04-27
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 11755 VICTORY BLVD
- Address line 2
- STE 211
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916063474