- Enrollment id
- O20240912000236
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1881348720
- Multiple npi flag
- N
- Ccn
- 758007
- Associate id
- 3779023148
- Organization name
- ACTIVE HOME HEALTH
- Incorporation date
- 2022-01-27
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6360 VAN NUYS BLVD
- Address line 2
- STE 201
- City
- VAN NUYS
- State
- CA
- Zip code
- 914016647
- Practice location type
- HHA BRANCH