- Enrollment id
- O20231117000568
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1821668443
- Multiple npi flag
- N
- Ccn
- 757640
- Associate id
- 1658728316
- Organization name
- PRIMARY SELECTION HOME HEALTH CARE, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14531 HAMLIN ST
- Address line 2
- STE 135
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114125