- Enrollment id
- O20180410000017
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1558724435
- Multiple npi flag
- N
- Ccn
- 053192
- Associate id
- 9830452663
- Organization name
- FAMILY CARE HOME HEALTH AGENCY, INC
- Incorporation date
- 2015-10-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15643 SHERMAN WAY
- Address line 2
- STE 210
- City
- VAN NUYS
- State
- CA
- Zip code
- 914068202