- Enrollment id
- O20170717002101
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1114916293
- Multiple npi flag
- N
- Ccn
- 555911
- Associate id
- 4284692096
- Organization name
- GLENDALE ADVENTIST MEDICAL CENTER
- Incorporation date
- 1905-08-26
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Nursing home provider name
- GLENDALE ADVENTIST MEDICAL CENTER DP/SNF
- Affiliation entity name
- ADVENTIST HEALTH
- Affiliation entity id
- 671
- Address line 1
- 1509 WILSON TER
- City
- GLENDALE
- State
- CA
- Zip code
- 912064007