- Enrollment id
- O20241031001725
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1548990302
- Multiple npi flag
- N
- Ccn
- 758058
- Associate id
- 2466985205
- Organization name
- LA MEMORIAL HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17620 SHERMAN WAY
- Address line 2
- STE 105A
- City
- VAN NUYS
- State
- CA
- Zip code
- 91406
- Practice location type
- HHA BRANCH