- Enrollment id
- O20221102000375
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1902573918
- Multiple npi flag
- N
- Ccn
- 757454
- Associate id
- 4183091259
- Organization name
- CALIFORNIA STATE HOME HEALTH AGENCY, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15545 DEVONSHIRE ST
- Address line 2
- UNIT 204
- City
- MISSION HILLS
- State
- CA
- Zip code
- 913452655