- Enrollment id
- O20230421000605
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1750939203
- Multiple npi flag
- N
- Ccn
- 757793
- Associate id
- 3274998554
- Organization name
- PRIME HOME HEALTH GROUP INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 19634 VENTURA BLVD
- Address line 2
- STE 204
- City
- TARZANA
- State
- CA
- Zip code
- 913562992