- Enrollment id
- O20230106001783
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1669198370
- Multiple npi flag
- N
- Ccn
- 757907
- Associate id
- 9638549751
- Organization name
- EMPYREAN HOME HEALTH, INC
- Incorporation date
- 2022-10-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 815 S CENTRAL AVE
- Address line 2
- STE 18
- City
- GLENDALE
- State
- CA
- Zip code
- 912042086