- Enrollment id
- O20221227000845
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1447861646
- Multiple npi flag
- N
- Ccn
- 757393
- Associate id
- 3971973454
- Organization name
- LIFE LINE HEALTH CARE SERVICES, INC.
- Incorporation date
- 2020-08-05
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE 218B
- City
- GLENDALE
- State
- CA
- Zip code
- 912032230