- Enrollment id
- O20230105000051
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1356924013
- Multiple npi flag
- N
- Ccn
- 757589
- Associate id
- 4880064096
- Organization name
- MEDAID HOME HEALTH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 639 S GLENWOOD PL
- Address line 2
- STE 107A
- City
- BURBANK
- State
- CA
- Zip code
- 915062819