- Enrollment id
- O20210628000014
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255891826
- Multiple npi flag
- N
- Ccn
- 559573
- Associate id
- 9537560610
- Organization name
- SKYLINE HOME HEALTH CARE INC
- Incorporation date
- 2019-02-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 14540 VICTORY BLVD
- Address line 2
- STE 208
- City
- VAN NUYS
- State
- CA
- Zip code
- 914114159