- Enrollment id
- O20231013001369
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1346810025
- Multiple npi flag
- N
- Ccn
- 757619
- Associate id
- 1951704618
- Organization name
- HEALTHY SMILES HOME HEALTH, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 VICTORY BLVD
- Address line 2
- STE 608
- City
- VAN NUYS
- State
- CA
- Zip code
- 91411