- Enrollment id
- O20221217000037
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1972198299
- Multiple npi flag
- N
- Ccn
- 757179
- Associate id
- 3678942422
- Organization name
- PRO AM HOME HEALTH
- Incorporation date
- 2021-02-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 127 S BRAND BLVD
- Address line 2
- STE 206
- City
- GLENDALE
- State
- CA
- Zip code
- 912041372
- Practice location type
- HHA BRANCH