- Enrollment id
- O20201114000023
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1801437454
- Multiple npi flag
- N
- Ccn
- 559469
- Associate id
- 0345650735
- Organization name
- ILLUMINATE HOME HEALTH CARE INC
- Incorporation date
- 2019-03-29
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 10545 BURBANK BLVD
- Address line 2
- STE 137
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916012249