- Enrollment id
- O20241021000165
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1467188144
- Multiple npi flag
- N
- Ccn
- 758089
- Associate id
- 9234671090
- Organization name
- ST GREGORY HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 664 W BROADWAY
- Address line 2
- STE E
- City
- GLENDALE
- State
- CA
- Zip code
- 912041097
- Practice location type
- HHA BRANCH