- Enrollment id
- O20201215001440
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1750980264
- Multiple npi flag
- N
- Ccn
- 757840
- Associate id
- 8022420157
- Organization name
- LIBORAH HOMEHEALTH
- Incorporation date
- 2020-10-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 237H
- City
- VAN NUYS
- State
- CA
- Zip code
- 914112397