- Enrollment id
- O20220616000089
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1417620584
- Multiple npi flag
- N
- Ccn
- 757127
- Associate id
- 8224417597
- Organization name
- STARS AND STRIPES HOME HEALTH
- Incorporation date
- 2021-07-15
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4605 LANKERSHIM BLVD
- Address line 2
- STE 209A
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916021874