- Enrollment id
- O20241016002982
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1639881022
- Multiple npi flag
- N
- Ccn
- 757973
- Associate id
- 6901338870
- Organization name
- FULL LIFE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14547 TITUS ST
- Address line 2
- STE 102
- City
- PANORAMA CITY
- State
- CA
- Zip code
- 914024912