- Enrollment id
- O20240503000246
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1255908364
- Multiple npi flag
- N
- Ccn
- 757646
- Associate id
- 9133515034
- Organization name
- SAINT VICTORIA HOME CARE
- Doing business as name
- SAINT VICTORIA HOME HEALTH CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6350 LAUREL CANYON BLVD
- Address line 2
- STE 202
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916063200