- Enrollment id
- O20200312001536
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1639632078
- Multiple npi flag
- N
- Ccn
- 559298
- Associate id
- 7315375979
- Organization name
- PRIMARY CARE HOMEHEALTHCARE INC
- Incorporation date
- 2019-04-10
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 203-2
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112397
- Practice location type
- HHA BRANCH