- Enrollment id
- O20191014000101
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1952807901
- Multiple npi flag
- N
- Ccn
- 559158
- Associate id
- 0244561835
- Organization name
- GREEN LIGHT HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6850 VAN NUYS BLVD
- Address line 2
- STE 311
- City
- VAN NUYS
- State
- CA
- Zip code
- 914054629