- Enrollment id
- O20190727000000
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1992219463
- Multiple npi flag
- N
- Ccn
- 559076
- Associate id
- 5496081507
- Organization name
- EAGLE HOME HEALTH
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6005 VINELAND AVE
- Address line 2
- STE 204
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916064984