- Enrollment id
- O20210503001025
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1568074441
- Multiple npi flag
- N
- Ccn
- 559645
- Associate id
- 2163831215
- Organization name
- ANGELS ON EARTH HEALTHCARE SERVICES, INC
- Incorporation date
- 2020-08-17
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1386 E WALNUT ST
- Address line 2
- STE 201
- City
- PASADENA
- State
- CA
- Zip code
- 911061510
- Practice location type
- HHA BRANCH