- Enrollment id
- O20221031000071
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1528655735
- Multiple npi flag
- N
- Ccn
- 757378
- Associate id
- 5597132811
- Organization name
- WELL CENTER HOME HEALTH
- Incorporation date
- 2020-12-07
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 401 N BRAND BLVD
- Address line 2
- STE 635B
- City
- GLENDALE
- State
- CA
- Zip code
- 912034447