- Enrollment id
- O20211020002214
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1790387512
- Multiple npi flag
- N
- Ccn
- 757561
- Associate id
- 0345638557
- Organization name
- HEROIC HOME HEALTH CARE
- Incorporation date
- 2020-08-03
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 135
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114712