- Enrollment id
- O20080104000268
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1821270851
- Multiple npi flag
- N
- Ccn
- 059142
- Associate id
- 5698855583
- Organization name
- US MEDTRADE HOME HEALTHCARE, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 221 E GLENOAKS BLVD
- Address line 2
- STE 100
- City
- GLENDALE
- State
- CA
- Zip code
- 912072119