- Enrollment id
- O20230817001321
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1538826565
- Multiple npi flag
- N
- Ccn
- 757631
- Associate id
- 7911369335
- Organization name
- LEA HOME HEALTH
- Incorporation date
- 2021-11-08
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6356 VAN NUYS BLVD
- Address line 2
- STE 232
- City
- VAN NUYS
- State
- CA
- Zip code
- 914012743