- Enrollment id
- O20160218001466
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1134505720
- Multiple npi flag
- N
- Ccn
- 555908
- Associate id
- 3072818640
- Organization name
- SOUTH PASADENA CARE CENTER, LLC
- Doing business as name
- SOUTH PASADENA CARE CENTER
- Incorporation date
- 2015-07-15
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SOUTH PASADENA CARE CENTER
- Address line 1
- 904 MISSION ST
- City
- SOUTH PASADENA
- State
- CA
- Zip code
- 910303144