- Enrollment id
- O20230524000440
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1487226502
- Multiple npi flag
- N
- Ccn
- 757643
- Associate id
- 0547626194
- Organization name
- PUREX HOME HEALTH SERVICES INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 11755 VICTORY BLVD
- Address line 2
- STE 104
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916063462