- Enrollment id
- O20210602000015
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1417538380
- Multiple npi flag
- N
- Ccn
- 753127
- Associate id
- 2860891413
- Organization name
- GLENWOOD HOME HEALTH INC
- Incorporation date
- 2021-03-07
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- STE 304B
- City
- GLENDALE
- State
- CA
- Zip code
- 912051008