- Enrollment id
- O20090825000592
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1629207287
- Multiple npi flag
- N
- Ccn
- 059387
- Associate id
- 2668527763
- Organization name
- ABC HOME HEALTH CARE LLC
- Doing business as name
- BRIDGE HOME HEALTH
- Incorporation date
- 2017-02-10
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5090 SHOREHAM PL
- Address line 2
- STE 109
- City
- SAN DIEGO
- State
- CA
- Zip code
- 921225934