- Enrollment id
- O20140917001738
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1699986034
- Multiple npi flag
- N
- Ccn
- 059678
- Associate id
- 5890605315
- Organization name
- PACIFIC HEALTH SERVICES, INC.
- Incorporation date
- 2003-03-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2501 W BURBANK BLVD
- Address line 2
- STE 309
- City
- BURBANK
- State
- CA
- Zip code
- 915052347