- Enrollment id
- O20230125001315
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1407507015
- Multiple npi flag
- N
- Ccn
- 757749
- Associate id
- 5890166128
- Organization name
- WHOLESOME HOME HEALTH, INC.
- Incorporation date
- 2021-12-01
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14531 HAMLIN ST
- Address line 2
- STE 180
- City
- VAN NUYS
- State
- CA
- Zip code
- 914111627