- Enrollment id
- O20110412000979
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1558661710
- Multiple npi flag
- N
- Ccn
- 059330
- Associate id
- 5799969952
- Organization name
- TRI-CARE HOME HEALTH SERVICES, INC.
- Incorporation date
- 2009-10-29
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14126 SHERMAN WAY
- Address line 2
- STE 11
- City
- VAN NUYS
- State
- CA
- Zip code
- 914055632
- Practice location type
- HHA BRANCH