- Enrollment id
- O20201028000149
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1346874062
- Multiple npi flag
- N
- Ccn
- 559467
- Associate id
- 7012327356
- Organization name
- PROVITAL CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 20953 DEVONSHIRE ST
- Address line 2
- STE 6
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913112371