- Enrollment id
- O20230523003576
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1376205641
- Multiple npi flag
- N
- Ccn
- 757607
- Associate id
- 0749646388
- Organization name
- ELYSIUM HOME HEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 5958 VINELAND AVE
- Address line 2
- STE J
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916011329