- Enrollment id
- O20210928001677
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1407426232
- Multiple npi flag
- N
- Ccn
- 757390
- Associate id
- 7517364995
- Organization name
- GK HOME HEALTH
- Incorporation date
- 2021-05-24
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14531 HAMLIN ST
- Address line 2
- STE 120
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114140