- Enrollment id
- O20181101000272
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1508267865
- Multiple npi flag
- N
- Ccn
- 559126
- Associate id
- 6204189657
- Organization name
- ODEN HOME HEALTH, LLC
- Incorporation date
- 2014-06-09
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 511 E HARVARD ST
- Address line 2
- STE 8
- City
- GLENDALE
- State
- CA
- Zip code
- 912051184
- Practice location type
- HHA BRANCH