- Enrollment id
- O20190530000889
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1285297291
- Multiple npi flag
- N
- Ccn
- 555921
- Associate id
- 8820331184
- Organization name
- MORENO VALLEY SNF LLC
- Doing business as name
- RANCHO BELLAGIO POST ACUTE
- Incorporation date
- 2018-03-16
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- RANCHO BELLAGIO POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 26940 E HOSPITAL RD
- City
- MORENO VALLEY
- State
- CA
- Zip code
- 925553923