- Enrollment id
- O20200619000331
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1518523380
- Multiple npi flag
- N
- Ccn
- 559753
- Associate id
- 5991136459
- Organization name
- TRICARE HOME HEALTH LLC
- Incorporation date
- 2019-04-15
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 17915 VENTURA BLVD
- Address line 2
- STE 204
- City
- ENCINO
- State
- CA
- Zip code
- 913164802
- Practice location type
- HHA BRANCH