- Enrollment id
- O20210527000033
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1831733849
- Multiple npi flag
- N
- Ccn
- 559535
- Associate id
- 9638578479
- Organization name
- QUEEN HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7200 VINELAND AVE
- Address line 2
- STE 209
- City
- SUN VALLEY
- State
- CA
- Zip code
- 913525089