- Enrollment id
- O20200921001430
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1306344353
- Multiple npi flag
- N
- Ccn
- 559701
- Associate id
- 8628496890
- Organization name
- SADDLEBACK HOME HEALTH SERVICES, INC.
- Incorporation date
- 2017-10-23
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 502 W ROUTE 66
- Address line 2
- STE 26
- City
- GLENDORA
- State
- CA
- Zip code
- 917404382