- Enrollment id
- O20050516000773
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1881777860
- Multiple npi flag
- N
- Ccn
- 058455
- Associate id
- 4385685759
- Organization name
- L.A. MEDICAL MANAGEMENT, INC.
- Doing business as name
- L.A. CARE PROVIDER
- Incorporation date
- 2004-06-01
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 11850 WILSHIRE BLVD
- Address line 2
- STE 102
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900256630