- Enrollment id
- O20040828000267
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1619944089
- Multiple npi flag
- N
- Ccn
- 557774
- Associate id
- 4082689500
- Organization name
- IDEAL HOME CARE, INC.
- Incorporation date
- 1996-02-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2117 FOOTHILL BLVD
- Address line 2
- STE J
- City
- LA VERNE
- State
- CA
- Zip code
- 917502902