- Enrollment id
- O20230207000863
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1629743703
- Multiple npi flag
- N
- Ccn
- 757994
- Associate id
- 2264804996
- Organization name
- BROAD HORIZON HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 127 S BRAND BLVD
- Address line 2
- STE 108
- City
- GLENDALE
- State
- CA
- Zip code
- 912041344