- Enrollment id
- O20190703000151
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1891259719
- Multiple npi flag
- N
- Ccn
- 559568
- Associate id
- 8123352663
- Organization name
- BLOOM HOME HEALTH INC
- Incorporation date
- 2018-07-11
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 13746 VICTORY BLVD
- Address line 2
- STE 216
- City
- VAN NUYS
- State
- CA
- Zip code
- 914016725