- Enrollment id
- O20200401002069
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1528531993
- Multiple npi flag
- N
- Ccn
- 559477
- Associate id
- 3678902319
- Organization name
- AVON HOME HEALTH CARE
- Incorporation date
- 2018-03-21
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14328 VICTORY BLVD
- Address line 2
- STE 207
- City
- VAN NUYS
- State
- CA
- Zip code
- 914016512