- Enrollment id
- O20190619000011
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962908756
- Multiple npi flag
- N
- Ccn
- 559118
- Associate id
- 7113251547
- Organization name
- EXPRESS HOME CARE
- Incorporation date
- 2015-06-10
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15643 SHERMAN WAY
- Address line 2
- STE 270
- City
- VAN NUYS
- State
- CA
- Zip code
- 914064135