- Enrollment id
- O20190605001106
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1063974285
- Multiple npi flag
- N
- Ccn
- 555431
- Associate id
- 6406189547
- Organization name
- EL CAJON POST ACUTE LLC
- Doing business as name
- COUNTRY HILLS POST ACUTE
- Incorporation date
- 2018-07-17
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COUNTRY HILLS POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 1580 BROADWAY
- City
- EL CAJON
- State
- CA
- Zip code
- 920215124