- Enrollment id
- O20230403000234
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1841958162
- Multiple npi flag
- N
- Ccn
- 757595
- Associate id
- 4688049869
- Organization name
- INNOVATIVE HOME HEALTH INC
- Incorporation date
- 2019-05-01
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1220 W GLENOAKS BLVD
- Address line 2
- STE 104A
- City
- GLENDALE
- State
- CA
- Zip code
- 912012231