- Enrollment id
- O20230530002923
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1336805787
- Multiple npi flag
- N
- Ccn
- 757470
- Associate id
- 6800253212
- Organization name
- VISTA HOME HEALTH
- Incorporation date
- 2021-07-27
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7335 TOPANGA CANYON BLVD
- Address line 2
- STE 200
- City
- CANOGA PARK
- State
- CA
- Zip code
- 913033392