- Enrollment id
- O20230324000172
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1770159618
- Multiple npi flag
- N
- Ccn
- 757549
- Associate id
- 6406220904
- Organization name
- GOG HOME HEALTH INC
- Incorporation date
- 2021-05-24
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1010 N CENTRAL AVE
- Address line 2
- STE 410
- City
- GLENDALE
- State
- CA
- Zip code
- 912022937