- Enrollment id
- O20201012002564
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1306483235
- Multiple npi flag
- N
- Ccn
- 559442
- Associate id
- 2466872528
- Organization name
- SOUTHLAND HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 3151 CAHUENGA BLVD W
- Address line 2
- STE 305
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900681768