- Enrollment id
- O20200212001872
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1407326796
- Multiple npi flag
- N
- Ccn
- 559473
- Associate id
- 8022444975
- Organization name
- RADIUM HOME HEALTH CARE, INC
- Incorporation date
- 2018-11-16
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 127 S BRAND BLVD
- Address line 2
- STE 326
- City
- GLENDALE
- State
- CA
- Zip code
- 912041389