- Enrollment id
- O20250122000918
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1942946645
- Multiple npi flag
- N
- Ccn
- 758067
- Associate id
- 1557890449
- Organization name
- FAMOUS HOME HEALTHCARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6454 VAN NUYS BLVD
- Address line 2
- STE 8
- City
- VAN NUYS
- State
- CA
- Zip code
- 914011445
- Practice location type
- HHA BRANCH