- Enrollment id
- O20150529002150
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1225425929
- Multiple npi flag
- N
- Ccn
- 555879
- Associate id
- 4981925187
- Organization name
- MAUBERTIDENCE OPCO, LLC
- Doing business as name
- ALL SAINTS MAUBERT
- Incorporation date
- 2014-09-25
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- ALL SAINT'S MAUBERT
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 15731 MAUBERT AVE
- City
- SAN LEANDRO
- State
- CA
- Zip code
- 945782014