- Enrollment id
- O20120518000404
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1134175201
- Multiple npi flag
- N
- Ccn
- 055293
- Associate id
- 7618130253
- Organization name
- SANTA ANITA CONVALESCENT HOSPITAL & RETIREMENT CENTER INC
- Doing business as name
- SANTA ANITA CONVALESCENT HOSPITAL
- Incorporation date
- 1968-03-22
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- SANTA ANITA CONVALESCENT HOSPITAL
- Address line 1
- 5522 GRACEWOOD AVE
- City
- ARCADIA
- State
- CA
- Zip code
- 910078409