- Enrollment id
- O20210629000366
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1902415086
- Multiple npi flag
- N
- Ccn
- 559602
- Associate id
- 6103227103
- Organization name
- ELTA HOME HEALTH CARE INC
- Incorporation date
- 2020-06-04
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6454 VAN NUYS BLVD
- Address line 2
- STE 6
- City
- VAN NUYS
- State
- CA
- Zip code
- 914011445