- Enrollment id
- O20240209000270
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1689300139
- Multiple npi flag
- N
- Ccn
- 757674
- Associate id
- 8921441684
- Organization name
- AGE WITH CARE HOME HEALTH INC
- Incorporation date
- 2022-06-21
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12501 CHANDLER BLVD
- Address line 2
- STE 101
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916071952