- Enrollment id
- O20220418000797
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1508478322
- Multiple npi flag
- N
- Ccn
- 753153
- Associate id
- 8628465820
- Organization name
- GUARDIAN ANGELS HOME HEALTHCARE INC
- Incorporation date
- 2020-06-01
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12509 OXNARD ST
- Address line 2
- STE 206
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916064443