- Enrollment id
- O20210727001947
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1689273625
- Multiple npi flag
- N
- Ccn
- 559575
- Associate id
- 0941603005
- Organization name
- LA PRIME HOME HEALTH INC
- Incorporation date
- 2020-08-24
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12444 VICTORY BLVD
- Address line 2
- STE 215
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916063199