- Enrollment id
- O20210821000015
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1538748058
- Multiple npi flag
- N
- Ccn
- 757190
- Associate id
- 4587069075
- Organization name
- GOLD COAST HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 16200 VENTURA BLVD
- Address line 2
- STE 407A
- City
- ENCINO
- State
- CA
- Zip code
- 914364697
- Practice location type
- HHA BRANCH