- Enrollment id
- O20241119002787
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1871273433
- Multiple npi flag
- N
- Ccn
- 757925
- Associate id
- 9234664814
- Organization name
- SHINE CARE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 22048 SHERMAN WAY
- Address line 2
- STE 216
- City
- CANOGA PARK
- State
- CA
- Zip code
- 913031841
- Practice location type
- HHA BRANCH