- Enrollment id
- O20070730000861
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1528265923
- Multiple npi flag
- N
- Ccn
- 059079
- Associate id
- 0547361867
- Organization name
- HEALTHY LIFE HOME CARE, INC.
- Incorporation date
- 2007-03-28
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 16661 VENTURA BLVD
- Address line 2
- STE 613
- City
- ENCINO
- State
- CA
- Zip code
- 914361985