- Enrollment id
- O20240412001248
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1487309894
- Multiple npi flag
- N
- Ccn
- 757689
- Associate id
- 3678912466
- Organization name
- HEALTHLINE HOME HEALTH AGENCY, INC.
- Incorporation date
- 2022-01-17
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 127 S BRAND BLVD
- Address line 2
- STE 302
- City
- GLENDALE
- State
- CA
- Zip code
- 912041388