- Enrollment id
- O20210423001217
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1891255329
- Multiple npi flag
- N
- Ccn
- 757054
- Associate id
- 3072921444
- Organization name
- MEDLINE HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 13746 VICTORY BLVD
- Address line 2
- STE 300
- City
- VAN NUYS
- State
- CA
- Zip code
- 914016725