- Enrollment id
- O20201118001217
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1407461668
- Multiple npi flag
- N
- Ccn
- 757026
- Associate id
- 5991116246
- Organization name
- HEALTHY WAY HOME HEALTH
- Incorporation date
- 2020-09-08
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6320 VAN NUYS BLVD
- Address line 2
- STE 207
- City
- VAN NUYS
- State
- CA
- Zip code
- 914012617