- Enrollment id
- O20201218002094
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1326645672
- Multiple npi flag
- N
- Ccn
- 757514
- Associate id
- 8325450174
- Organization name
- IMPACT HOME HEALTH CARE INC
- Incorporation date
- 2020-09-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 16430 VENTURA BLVD
- Address line 2
- STE 202A
- City
- ENCINO
- State
- CA
- Zip code
- 914362125