- Enrollment id
- O20221114000144
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1851040174
- Multiple npi flag
- N
- Ccn
- 757904
- Associate id
- 4981071420
- Organization name
- EVITA HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 500 E OLIVE AVE
- Address line 2
- STE 310
- City
- BURBANK
- State
- CA
- Zip code
- 915012171