- Enrollment id
- O20200820002458
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1477115400
- Multiple npi flag
- N
- Ccn
- 559496
- Associate id
- 6709202757
- Organization name
- HEALTHY HEARTS HOME HEALTH INC
- Incorporation date
- 2019-05-21
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14664 VICTORY BLVD
- Address line 2
- # 206
- City
- VAN NUYS
- State
- CA
- Zip code
- 914111621
- Practice location type
- HHA BRANCH