- Enrollment id
- O20180320002997
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1558800243
- Multiple npi flag
- N
- Ccn
- 553155
- Associate id
- 4183901978
- Organization name
- COLUSA MEDICAL CENTER, LLC
- Doing business as name
- COLUSA MEDICAL CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 199 E WEBSTER ST
- City
- COLUSA
- State
- CA
- Zip code
- 959322954