- Enrollment id
- O20231219002021
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1366111650
- Multiple npi flag
- N
- Ccn
- 757624
- Associate id
- 3072963925
- Organization name
- GLENDALE HOME INC
- Incorporation date
- 2021-07-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1545 N VERDUGO RD
- Address line 2
- STE 206
- City
- GLENDALE
- State
- CA
- Zip code
- 912082804