- Enrollment id
- O20221213000760
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1629737184
- Multiple npi flag
- N
- Ccn
- 757510
- Associate id
- 2668841776
- Organization name
- AG HOME HEALTH SERVICES
- Incorporation date
- 2021-11-04
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 260 S LOS ROBLES AVE
- Address line 2
- STE 309
- City
- PASADENA
- State
- CA
- Zip code
- 911012897