- Enrollment id
- O20200212001226
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1629535380
- Multiple npi flag
- N
- Ccn
- 559227
- Associate id
- 3779919600
- Organization name
- SUDARIO HOME HEALTH CARE INC
- Incorporation date
- 2019-01-10
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 220 S KENWOOD ST
- Address line 2
- STE 202
- City
- GLENDALE
- State
- CA
- Zip code
- 912051671