- Enrollment id
- O20200908002863
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1306460894
- Multiple npi flag
- N
- Ccn
- 559758
- Associate id
- 8224456272
- Organization name
- 5 STAR HOME HEALTH CARE INC
- Incorporation date
- 2020-05-15
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14126 SHERMAN WAY
- Address line 2
- UNIT #10
- City
- VAN NUYS
- State
- CA
- Zip code
- 914055632