- Enrollment id
- O20161215001902
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1790144830
- Multiple npi flag
- N
- Ccn
- 053128
- Associate id
- 0345520037
- Organization name
- GLORY HOME HEALTH, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3111 LOS FELIZ BLVD
- Address line 2
- STE 203
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900391585