- Enrollment id
- O20211028000462
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1669042156
- Multiple npi flag
- N
- Ccn
- 757165
- Associate id
- 9638567449
- Organization name
- PROTECTIVE HOME HEALTH CARE INC
- Incorporation date
- 2020-08-15
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 221 E GLENOAKS BLVD
- Address line 2
- UNIT 222A
- City
- GLENDALE
- State
- CA
- Zip code
- 912072085