- Enrollment id
- O20200909001164
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1760047898
- Multiple npi flag
- N
- Ccn
- 559458
- Associate id
- 4688092570
- Organization name
- PRUDENCE HOME HEALTH CARE INC
- Incorporation date
- 2019-04-19
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 11755 VICTORY BLVD
- Address line 2
- STE 204
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916063453
- Practice location type
- HHA BRANCH