- Enrollment id
- O20240805000839
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1366194557
- Multiple npi flag
- N
- Ccn
- 757889
- Associate id
- 7618414988
- Organization name
- LIGHT HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 262
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112397