- Enrollment id
- O20230208000068
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1851975585
- Multiple npi flag
- N
- Ccn
- 757327
- Associate id
- 3870965452
- Organization name
- GREAT LIFE HOME HEALTH INC
- Incorporation date
- 2021-04-26
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15720 VENTURA BLVD
- Address line 2
- STE 608
- City
- ENCINO
- State
- CA
- Zip code
- 914364732