- Enrollment id
- O20230814001938
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1407423379
- Multiple npi flag
- N
- Ccn
- 757692
- Associate id
- 7416319074
- Organization name
- MK HOME HEALTH SERVICES
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 512 E WILSON AVE
- Address line 2
- STE 314
- City
- GLENDALE
- State
- CA
- Zip code
- 912064351