- Enrollment id
- O20240604002111
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1518627967
- Multiple npi flag
- N
- Ccn
- 758195
- Associate id
- 0941742118
- Organization name
- DISTINCT HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14547 TITUS ST
- Address line 2
- STE 212B
- City
- PANORAMA CITY
- State
- CA
- Zip code
- 914024924
- Practice location type
- HHA BRANCH