- Enrollment id
- O20230421000429
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1750959185
- Multiple npi flag
- N
- Ccn
- 757343
- Associate id
- 0840655122
- Organization name
- MAIN HOME HEALTH CARE, INC
- Incorporation date
- 2021-06-04
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14531 HAMLIN ST
- Address line 2
- STE 130
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114122