- Enrollment id
- O20180208001152
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1508379181
- Multiple npi flag
- N
- Ccn
- 553189
- Associate id
- 2365702560
- Organization name
- OPTIMUM MA HOME HEALTH CARE, INC
- Incorporation date
- 2017-09-08
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5658 SEPULVEDA BLVD
- Address line 2
- STE 208
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112927