- Enrollment id
- O20180221002750
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1023534443
- Multiple npi flag
- N
- Ccn
- 555595
- Associate id
- 1658632229
- Organization name
- GHC OF SAN RAFAEL, LLC
- Doing business as name
- SMITH RANCH SKILLED NURSING & REHABILITATION CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SMITH RANCH SKILLED NURSING & REHABILITATION CENTE
- Affiliation entity name
- GENERATIONS HEALTHCARE
- Affiliation entity id
- 236
- Address line 1
- 1550 SILVEIRA PKWY
- City
- SAN RAFAEL
- State
- CA
- Zip code
- 949034879