- Enrollment id
- O20211222000549
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1033884473
- Multiple npi flag
- N
- Ccn
- 555926
- Associate id
- 5092106336
- Organization name
- GREY PINE HOLDINGS, LLC
- Doing business as name
- SHADELANDS POST ACUTE
- Incorporation date
- 2018-10-11
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SHADELANDS POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 2765 MITCHELL DR
- City
- WALNUT CREEK
- State
- CA
- Zip code
- 945981601