- Enrollment id
- O20210506001754
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1972137891
- Multiple npi flag
- N
- Ccn
- 559723
- Associate id
- 1456760214
- Organization name
- CALSTATE HEALTHCARE INC.
- Doing business as name
- CALSTATE HEALTHCARE INC.
- Incorporation date
- 2019-10-30
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6308 WOODMAN AVE
- Address line 2
- STE 107
- City
- VAN NUYS
- State
- CA
- Zip code
- 914012373