- Enrollment id
- O20210805000049
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1679151344
- Multiple npi flag
- N
- Ccn
- 757136
- Associate id
- 5799189262
- Organization name
- HEALTHY CA HOME HEALTH
- Incorporation date
- 2021-03-08
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 300 N 3RD ST
- Address line 2
- STE 308
- City
- BURBANK
- State
- CA
- Zip code
- 915021107