- Enrollment id
- O20220629002553
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1992344873
- Multiple npi flag
- N
- Ccn
- 757072
- Associate id
- 8325428998
- Organization name
- HEALING HOME HEALTH
- Incorporation date
- 2019-06-14
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 815 S CENTRAL AVE
- Address line 2
- STE 4
- City
- GLENDALE
- State
- CA
- Zip code
- 912042073
- Practice location type
- HHA BRANCH