- Enrollment id
- O20220510000696
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1750976635
- Multiple npi flag
- N
- Ccn
- 753192
- Associate id
- 7618354853
- Organization name
- SAINT GEORGE HOME HEALTH
- Incorporation date
- 2021-02-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 127 S BRAND BLVD
- Address line 2
- STE 218
- City
- GLENDALE
- State
- CA
- Zip code
- 912041373