- Enrollment id
- O20210823000717
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1891372272
- Multiple npi flag
- N
- Ccn
- 757203
- Associate id
- 0042615577
- Organization name
- LIVING TREE HOME HEALTH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5301 LAUREL CANYON BLVD
- Address line 2
- STE 226
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916072788