- Enrollment id
- O20201120001746
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1538609961
- Multiple npi flag
- N
- Ccn
- 753181
- Associate id
- 7517386808
- Organization name
- HEALTHY LIFE HOME SERVICES INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4730 WOODMAN AVE
- Address line 2
- STE 305
- City
- SHERMAN OAKS
- State
- CA
- Zip code
- 914232427