- Enrollment id
- O20200829000004
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1427514058
- Multiple npi flag
- N
- Ccn
- 559452
- Associate id
- 8426475948
- Organization name
- SILVERLAKE TOTAL CARE INC
- Incorporation date
- 2018-01-29
- Incorporation state
- CO
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2252 BEVERLY BLVD
- Address line 2
- STE 207
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900572236