- Enrollment id
- O20221031002270
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1972188795
- Multiple npi flag
- N
- Ccn
- 757219
- Associate id
- 1052788221
- Organization name
- LUSTY HOME HEALTH INC
- Incorporation date
- 2021-02-11
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 209 E ALAMEDA AVE
- Address line 2
- STE 104
- City
- BURBANK
- State
- CA
- Zip code
- 915022672