- Enrollment id
- O20191016001037
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1457800062
- Multiple npi flag
- N
- Ccn
- 559347
- Associate id
- 1355672718
- Organization name
- MAGNA VITAE
- Incorporation date
- 2016-05-16
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7200 VINELAND AVE
- Address line 2
- UNIT 214
- City
- SUN VALLEY
- State
- CA
- Zip code
- 913525088