- Enrollment id
- O20220329000270
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1861159774
- Multiple npi flag
- N
- Ccn
- 757409
- Associate id
- 3072908169
- Organization name
- GREEN ORCHID HOME HEALTH INC
- Incorporation date
- 2021-11-24
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- STE B117A
- City
- GLENDALE
- State
- CA
- Zip code
- 912051008