- Enrollment id
- O20200826001510
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1689284606
- Multiple npi flag
- N
- Ccn
- 559780
- Associate id
- 6608293394
- Organization name
- SOCAL INTEGRATED CARE INC
- Incorporation date
- 2020-06-30
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 1220 W GLENOAKS BLVD
- Address line 2
- STE 102
- City
- GLENDALE
- State
- CA
- Zip code
- 912012298