- Enrollment id
- O20181001002776
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1891273181
- Multiple npi flag
- N
- Ccn
- 757166
- Associate id
- 6709137748
- Organization name
- COLORADO RIVER HOME HEALTH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 9003 RESEDA BLVD
- Address line 2
- STE 208
- City
- NORTHRIDGE
- State
- CA
- Zip code
- 913243965