- Enrollment id
- O20240705000994
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1922877299
- Multiple npi flag
- N
- Ccn
- 757865
- Associate id
- 0840734513
- Organization name
- BENOM HOME HEALTH CARE, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14531 HAMLIN ST
- Address line 2
- STE 255
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114126