- Enrollment id
- O20191105001684
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1699241091
- Multiple npi flag
- N
- Ccn
- 559199
- Associate id
- 3173855475
- Organization name
- MEDICUS HOME HEALTH AGENCY
- Incorporation date
- 2018-09-12
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 21032 DEVONSHIRE ST
- Address line 2
- UNIT 202B
- City
- CHATSWORTH
- State
- CA
- Zip code
- 913112368