- Enrollment id
- O20210802001141
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1396336962
- Multiple npi flag
- N
- Ccn
- 757161
- Associate id
- 6305251596
- Organization name
- BELOVED HOME HEALTH INC
- Incorporation date
- 2021-01-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2500 E FOOTHILL BLVD
- Address line 2
- STE 203
- City
- PASADENA
- State
- CA
- Zip code
- 911077114