- Enrollment id
- O20241108000916
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1508513334
- Multiple npi flag
- N
- Ccn
- 758114
- Associate id
- 9234578287
- Organization name
- OSAA HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE 618C
- City
- GLENDALE
- State
- CA
- Zip code
- 912033667