- Enrollment id
- O20200812002813
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1730714171
- Multiple npi flag
- N
- Ccn
- 757130
- Associate id
- 6507130473
- Organization name
- CITADEL & IVAN LLC
- Doing business as name
- GENTLE CARE HOMEHEALTH
- Incorporation date
- 2016-08-16
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 5100 N 6TH ST
- Address line 2
- STE 154
- City
- FRESNO
- State
- CA
- Zip code
- 937107515