- Enrollment id
- O20200113001037
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1982250106
- Multiple npi flag
- N
- Ccn
- 559582
- Associate id
- 5193150571
- Organization name
- NOVA VITA HEALTH SERVICES INC
- Incorporation date
- 2019-02-04
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1241 S GLENDALE AVE
- Address line 2
- STE 202C
- City
- GLENDALE
- State
- CA
- Zip code
- 912053388