- Enrollment id
- O20230317000384
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1467120527
- Multiple npi flag
- N
- Ccn
- 757530
- Associate id
- 9537533310
- Organization name
- WELLSPRING HOME HEALTH CARE, INC
- Incorporation date
- 2021-08-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17050 CHATSWORTH ST
- Address line 2
- UNIT 101A
- City
- GRANADA HILLS
- State
- CA
- Zip code
- 913445847