- Enrollment id
- O20201019002345
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1861002453
- Multiple npi flag
- N
- Ccn
- 559560
- Associate id
- 5799105482
- Organization name
- ACTIVE LIGHT HOME HEALTH INC
- Incorporation date
- 2020-07-29
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 150 E OLIVE AVE
- Address line 2
- STE 109
- City
- BURBANK
- State
- CA
- Zip code
- 915021849