- Enrollment id
- O20241210000307
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1770291296
- Multiple npi flag
- N
- Ccn
- 758017
- Associate id
- 3072049410
- Organization name
- SEROV HOME HEALTH LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 126 S JACKSON ST
- Address line 2
- STE 200
- City
- GLENDALE
- State
- CA
- Zip code
- 912054920
- Practice location type
- HHA BRANCH