- Enrollment id
- O20210524000033
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1881242378
- Multiple npi flag
- N
- Ccn
- 757075
- Associate id
- 8022417153
- Organization name
- LA VIDA HOME HEALTH, INC
- Incorporation date
- 2019-07-31
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 348 E OLIVE AVE
- Address line 2
- STE G
- City
- BURBANK
- State
- CA
- Zip code
- 915021250