- Enrollment id
- O20200901001082
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1467004101
- Multiple npi flag
- N
- Ccn
- 559334
- Associate id
- 3375960628
- Organization name
- EXPRESS HOMESERVICE INC
- Incorporation date
- 2019-05-08
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7220 WOODMAN AVE
- Address line 2
- STE 205
- City
- VAN NUYS
- State
- CA
- Zip code
- 914052668