- Enrollment id
- O20241111000127
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1639820335
- Multiple npi flag
- N
- Ccn
- 758031
- Associate id
- 1759758923
- Organization name
- KK HOME HEALTH CARE INC
- Incorporation date
- 2022-01-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 325
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112397
- Practice location type
- HHA BRANCH