- Enrollment id
- O20210924001687
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1437745759
- Multiple npi flag
- N
- Ccn
- 559677
- Associate id
- 2961809595
- Organization name
- FOUR SEASONS HEALTHCARE INC
- Incorporation date
- 2020-12-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 19231 VICTORY BLVD
- Address line 2
- STE 554
- City
- RESEDA
- State
- CA
- Zip code
- 913356373