- Enrollment id
- O20200520000106
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1215592639
- Multiple npi flag
- N
- Ccn
- 559284
- Associate id
- 1153752555
- Organization name
- SDA HOME HEALTH CARE SERVICES
- Incorporation date
- 2018-12-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1864 E WASHINGTON BLVD
- Address line 2
- STE 202
- City
- PASADENA
- State
- CA
- Zip code
- 911041667