- Enrollment id
- O20201224000110
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1851990113
- Multiple npi flag
- N
- Ccn
- 753198
- Associate id
- 7618389271
- Organization name
- OFFICIAL HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4119 W BURBANK BLVD
- Address line 2
- STE 124
- City
- BURBANK
- State
- CA
- Zip code
- 915052122