- Enrollment id
- O20161202000231
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1932558103
- Multiple npi flag
- N
- Ccn
- 553149
- Associate id
- 1850671140
- Organization name
- ON TIME HEALTH CARE INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 126 S JACKSON ST
- Address line 2
- STE 206
- City
- GLENDALE
- State
- CA
- Zip code
- 912054920
- Practice location type
- HHA BRANCH