- Enrollment id
- O20201117002543
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1548878317
- Multiple npi flag
- N
- Ccn
- 559684
- Associate id
- 4284045592
- Organization name
- PROVISION HOME HEALTH CARE
- Incorporation date
- 2017-04-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5311 TOPANGA CANYON BLVD
- Address line 2
- UNIT 308C
- City
- WOODLAND HILLS
- State
- CA
- Zip code
- 913641754