- Enrollment id
- O20220613000067
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1740913896
- Multiple npi flag
- N
- Ccn
- 757240
- Associate id
- 7810375359
- Organization name
- SOCAL HOME HEALTH CARE INC
- Incorporation date
- 2020-01-27
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12509 OXNARD ST
- Address line 2
- STE 215
- City
- NORTH HOLLYWOOD
- State
- CA
- Zip code
- 916064443