- Enrollment id
- O20140211000534
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1609115021
- Multiple npi flag
- N
- Ccn
- 059723
- Associate id
- 6305075599
- Organization name
- VIDA HEALTHCARE SYSTEMS, LLC
- Doing business as name
- VIDA CARE HOME HEALTH
- Incorporation date
- 2012-08-21
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5100 N 6TH ST
- Address line 2
- STE 112
- City
- FRESNO
- State
- CA
- Zip code
- 937107506