- Enrollment id
- O20121205000423
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1942561071
- Multiple npi flag
- N
- Ccn
- 059577
- Associate id
- 6406008093
- Organization name
- VIDA HOME HEALTH SERVICES., INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3800 W BURBANK BLVD
- Address line 2
- STE 101
- City
- BURBANK
- State
- CA
- Zip code
- 915052148