- Enrollment id
- O20211124001561
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1336601970
- Multiple npi flag
- N
- Ccn
- 757232
- Associate id
- 3274923735
- Organization name
- FIRSTMED HOME HEALTH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17620 SHERMAN WAY
- Address line 2
- STE 209
- City
- VAN NUYS
- State
- CA
- Zip code
- 914063527