- Enrollment id
- O20210914002763
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1487203832
- Multiple npi flag
- N
- Ccn
- 559655
- Associate id
- 1456751635
- Organization name
- BRIGHTLANE HEALTHCARE INC
- Incorporation date
- 2016-08-30
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5050 PALO VERDE ST
- Address line 2
- STE 212
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632334
- Practice location type
- HHA BRANCH