- Enrollment id
- O20190619000053
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1316402597
- Multiple npi flag
- N
- Ccn
- 559690
- Associate id
- 9830423268
- Organization name
- ELYSIUM HOME HEALTH CARE
- Incorporation date
- 2018-11-06
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 13746 VICTORY BLVD
- Address line 2
- STE 214
- City
- VAN NUYS
- State
- CA
- Zip code
- 914016716
- Practice location type
- HHA BRANCH