- Enrollment id
- O20190724002329
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1609348887
- Multiple npi flag
- N
- Ccn
- 559194
- Associate id
- 8022344324
- Organization name
- GLORIA HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14640 VICTORY BLVD
- Address line 2
- STE 201
- City
- VAN NUYS
- State
- CA
- Zip code
- 914111623