- Enrollment id
- O20210104001005
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1598365793
- Multiple npi flag
- N
- Ccn
- 753159
- Associate id
- 9032520150
- Organization name
- HDE HOME HEALTH CARE INC
- Incorporation date
- 2020-09-24
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- STE B103B
- City
- GLENDALE
- State
- CA
- Zip code
- 912051008
- Practice location type
- HHA BRANCH