- Enrollment id
- O20231211002331
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1346915881
- Multiple npi flag
- N
- Ccn
- 757961
- Associate id
- 0840649240
- Organization name
- KIAS HH INC
- Incorporation date
- 2021-07-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 281
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114708