- Enrollment id
- O20230203000060
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1376214361
- Multiple npi flag
- N
- Ccn
- 757681
- Associate id
- 6507238482
- Organization name
- ANGEL WINGS HOME HEALTH INC.
- Incorporation date
- 2021-08-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5958 VINELAND AVE
- Address line 2
- STE G
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916011329