- Enrollment id
- O20240618002511
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1902556624
- Multiple npi flag
- N
- Ccn
- 757927
- Associate id
- 2264975218
- Organization name
- ETERNAL HOME HEALTH CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2600 FOOTHILL BLVD
- Address line 2
- STE 208
- City
- LA CRESCENTA
- State
- CA
- Zip code
- 912144579