- Enrollment id
- O20180221000856
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1184140964
- Multiple npi flag
- N
- Ccn
- 555910
- Associate id
- 9638430374
- Organization name
- MACADAMIA HOLDINGS, LLC
- Doing business as name
- TRELLIS CHINO
- Incorporation date
- 2016-06-06
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- TRELLIS CHINO
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 5454 WALNUT AVE
- City
- CHINO
- State
- CA
- Zip code
- 917102600