- Enrollment id
- O20240808002809
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1982374773
- Multiple npi flag
- N
- Ccn
- 758101
- Associate id
- 7719424639
- Organization name
- WHOLE HEART HOME HEALTH AGENCY, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 121 W LEXINGTON DR
- Address line 2
- STE 206D
- City
- GLENDALE
- State
- CA
- Zip code
- 912032230