- Enrollment id
- O20180612001131
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1760922496
- Multiple npi flag
- N
- Ccn
- 559572
- Associate id
- 0840545067
- Organization name
- ADVANCED QUALITY HOME CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6454 VAN NUYS BLVD
- Address line 2
- STE 111
- City
- VAN NUYS
- State
- CA
- Zip code
- 914011445