- Enrollment id
- O20201002002554
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1871132902
- Multiple npi flag
- N
- Ccn
- 559524
- Associate id
- 4183043524
- Organization name
- STAT HOME HEALTH INC
- Incorporation date
- 2018-10-23
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 9700 RESEDA BLVD
- Address line 2
- STE 202
- City
- NORTHRIDGE
- State
- CA
- Zip code
- 913245511