- Enrollment id
- O20210406001272
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962097030
- Multiple npi flag
- N
- Ccn
- 753137
- Associate id
- 6709293970
- Organization name
- SYLVAN HEALTH SERVICES INC
- Incorporation date
- 2021-02-24
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12722 RIVERSIDE DR
- Address line 2
- STE 209
- City
- VALLEY VILLAGE
- State
- CA
- Zip code
- 916073356