- Enrollment id
- O20200210002195
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1881243939
- Multiple npi flag
- N
- Ccn
- 559315
- Associate id
- 4183050206
- Organization name
- GLENDALE HOME HEALTH, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2600 FOOTHILL BLVD
- Address line 2
- STE 207
- City
- LA CRESCENTA
- State
- CA
- Zip code
- 912144579