- Enrollment id
- O20240501002091
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1821726597
- Multiple npi flag
- N
- Ccn
- 757936
- Associate id
- 1052751559
- Organization name
- DISTINCTIVE HOME HEALTH CARE INC
- Incorporation date
- 2021-03-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12501 CHANDLER BLVD
- Address line 2
- STE 104
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916071958