- Enrollment id
- O20240705002222
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962159442
- Multiple npi flag
- N
- Ccn
- 757992
- Associate id
- 3375087075
- Organization name
- BLUE HORIZON PK INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7590 N GLENOAKS BLVD
- Address line 2
- STE 110
- City
- BURBANK
- State
- CA
- Zip code
- 915041003