- Enrollment id
- O20240925000146
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1689446908
- Multiple npi flag
- N
- Ccn
- 757975
- Associate id
- 0143761551
- Organization name
- FIRST SERENITY HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 13758 VICTORY BLVD
- Address line 2
- STE 203
- City
- VAN NUYS
- State
- CA
- Zip code
- 914016731
- Practice location type
- HHA BRANCH