- Enrollment id
- O20070316000309
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1720251440
- Multiple npi flag
- N
- Ccn
- 058477
- Associate id
- 3375646003
- Organization name
- GIBRALTAR HOME HEALTH SERVICES, LLC
- Incorporation date
- 2006-04-10
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 22141 VENTURA BLVD
- Address line 2
- STE 300
- City
- WOODLAND HILLS
- State
- CA
- Zip code
- 913645734