- Enrollment id
- O20221210000036
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962078493
- Multiple npi flag
- N
- Ccn
- 757365
- Associate id
- 5799166807
- Organization name
- WELLNESS MIND HOME HEALTH CARE
- Incorporation date
- 2021-04-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 209 E ALAMEDA AVE
- Address line 2
- STE 103
- City
- BURBANK
- State
- CA
- Zip code
- 915022673