- Enrollment id
- O20210528001961
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1922619923
- Multiple npi flag
- N
- Ccn
- 559651
- Associate id
- 0749689412
- Organization name
- FORTUNE HEALTH CARE SERVICES INC
- Incorporation date
- 2019-11-13
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 225 E BROADWAY
- Address line 2
- STE 104
- City
- GLENDALE
- State
- CA
- Zip code
- 912051008
- Practice location type
- HHA BRANCH