- Enrollment id
- O20220629000598
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1881295251
- Multiple npi flag
- N
- Ccn
- 757254
- Associate id
- 5395140636
- Organization name
- LOYAL HOME HEALTH SERVICES
- Incorporation date
- 2020-10-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4119 W BURBANK BLVD
- Address line 2
- STE 173
- City
- BURBANK
- State
- CA
- Zip code
- 915052122