- Enrollment id
- O20240923001312
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1417534488
- Multiple npi flag
- N
- Ccn
- 758234
- Associate id
- 5890145544
- Organization name
- SAMOHOME INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 18747 SHERMAN WAY
- Address line 2
- STE 226
- City
- RESEDA
- State
- CA
- Zip code
- 913354000