- Enrollment id
- O20190523000160
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1396285151
- Multiple npi flag
- N
- Ccn
- 559271
- Associate id
- 4486997087
- Organization name
- HOLY CARE HOME HEALTH AND PALLIATIVE CARE
- Incorporation date
- 2016-05-31
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 13758 VICTORY BLVD
- Address line 2
- STE 210
- City
- VAN NUYS
- State
- CA
- Zip code
- 914012359