- Enrollment id
- O20230908000395
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1467104489
- Multiple npi flag
- N
- Ccn
- 757566
- Associate id
- 9638533789
- Organization name
- STONEBRIDGE HHA
- Incorporation date
- 2022-01-15
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 209 E ALAMEDA AVE
- Address line 2
- UNIT 200B
- City
- BURBANK
- State
- CA
- Zip code
- 915022672