- Enrollment id
- O20190724000034
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1881127215
- Multiple npi flag
- N
- Ccn
- 559169
- Associate id
- 8527394964
- Organization name
- ADVANCED WELLNESS HOMECARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4959 PALO VERDE ST
- Address line 2
- STE 206C-5
- City
- MONTCLAIR
- State
- CA
- Zip code
- 917632341