- Enrollment id
- O20250116001853
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1922719855
- Multiple npi flag
- N
- Ccn
- 757953
- Associate id
- 6305374422
- Organization name
- PRIME CARE SERVICES, INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14545 FRIAR ST
- Address line 2
- STE 120
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114712
- Practice location type
- HHA BRANCH