- Enrollment id
- O20220414000306
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1689262487
- Multiple npi flag
- N
- Ccn
- 757164
- Associate id
- 9234525528
- Organization name
- LAGLEN HOME INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 353 E ANGELENO AVE
- Address line 2
- STE M
- City
- BURBANK
- State
- CA
- Zip code
- 915021310