- Enrollment id
- O20190607001918
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1750734844
- Multiple npi flag
- N
- Ccn
- 559024
- Associate id
- 0648550202
- Organization name
- ST. MARCOS HOME & PALLIATIVE CARE INC
- Incorporation date
- 2016-06-30
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 401 N BRAND BLVD
- Address line 2
- STE 244
- City
- GLENDALE
- State
- CA
- Zip code
- 912034443