- Enrollment id
- O20210506002655
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1700478336
- Multiple npi flag
- N
- Ccn
- 757307
- Associate id
- 6103235981
- Organization name
- SUCCESS HOME CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE 402
- City
- GLENDALE
- State
- CA
- Zip code
- 912032230