- Enrollment id
- O20211006000080
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1528657483
- Multiple npi flag
- N
- Ccn
- 059050
- Associate id
- 6406254416
- Organization name
- RENAISSANCE HOME HEALTH SERVICES INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 512 E WILSON AVE
- Address line 2
- STE 203
- City
- GLENDALE
- State
- CA
- Zip code
- 912064351