- Enrollment id
- O20070720000776
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1417158916
- Multiple npi flag
- N
- Ccn
- 059119
- Associate id
- 9436250495
- Organization name
- PROGRESSIVE HOME HEALTH CARE, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1314 W GLENOAKS BLVD
- Address line 2
- STE 204
- City
- GLENDALE
- State
- CA
- Zip code
- 912013146