- Enrollment id
- O20201120001427
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1629566740
- Multiple npi flag
- N
- Ccn
- 753111
- Associate id
- 6709297898
- Organization name
- ANGEL CITY HOME HEALTH, INC.
- Incorporation date
- 2018-02-26
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 511 E HARVARD ST
- Address line 2
- STE 5
- City
- GLENDALE
- State
- CA
- Zip code
- 912051184