- Enrollment id
- O20240827000463
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1750012886
- Multiple npi flag
- N
- Ccn
- 757881
- Associate id
- 0840739579
- Organization name
- CREDENCE HOME HEALTH CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 512 E WILSON AVE
- Address line 2
- STE 303
- City
- GLENDALE
- State
- CA
- Zip code
- 912064351
- Practice location type
- HHA BRANCH