- Enrollment id
- O20220322000027
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1558964155
- Multiple npi flag
- N
- Ccn
- 757062
- Associate id
- 6507251956
- Organization name
- AHG HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 229 N CENTRAL AVE
- Address line 2
- STE 505
- City
- GLENDALE
- State
- CA
- Zip code
- 912033540