- Enrollment id
- O20041221001067
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1427150978
- Multiple npi flag
- N
- Ccn
- 059032
- Associate id
- 6800854886
- Organization name
- ANGELS ON EARTH HOME HEALTH INC
- Incorporation date
- 2009-11-15
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 201A
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632339