- Enrollment id
- O20210924000512
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1417542473
- Multiple npi flag
- N
- Ccn
- 559716
- Associate id
- 6608273206
- Organization name
- PRIMARY CHOICE HOME HEALTH CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5658 SEPULVEDA BLVD
- Address line 2
- STE 302
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112915