- Enrollment id
- O20070806000802
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1659577971
- Multiple npi flag
- N
- Ccn
- 059161
- Associate id
- 4082705025
- Organization name
- PROFESSIONAL NURSING, INC.
- Incorporation date
- 2007-05-25
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12501 CHANDLER BLVD
- Address line 2
- STE 205
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916071938
- Practice location type
- HHA BRANCH