- Enrollment id
- O20231206001183
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1538827480
- Multiple npi flag
- N
- Ccn
- 757706
- Associate id
- 5395194161
- Organization name
- EMERALD HEARTS HEALTHCARE
- Incorporation date
- 2021-11-29
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 19626 VENTURA BLVD
- Address line 2
- UNIT 220A
- City
- TARZANA
- State
- CA
- Zip code
- 913562944