- Enrollment id
- O20230501000767
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1689331399
- Multiple npi flag
- N
- Ccn
- 757559
- Associate id
- 5395113138
- Organization name
- A & V HOME HEALTH CARE SERVICES
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3171 LOS FELIZ BLVD
- Address line 2
- STE 302
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900391537