- Enrollment id
- O20210430000124
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1861072340
- Multiple npi flag
- N
- Ccn
- 059750
- Associate id
- 2769891944
- Organization name
- NEOGEN CARE CORP
- Incorporation date
- 2021-03-12
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1241 S GLENDALE AVE
- Address line 2
- STE 203
- City
- GLENDALE
- State
- CA
- Zip code
- 912053388