- Enrollment id
- O20180219001722
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1457889511
- Multiple npi flag
- N
- Ccn
- 559624
- Associate id
- 7214298058
- Organization name
- COASTLINE HOME HEALTHCARE INC
- Incorporation date
- 2017-01-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 10117 SEPULVEDA BLVD
- Address line 2
- SUITE 205B
- City
- MISSION HILLS
- State
- CA
- Zip code
- 913452600
- Practice location type
- HHA BRANCH