- Enrollment id
- O20030424000025
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1285670851
- Multiple npi flag
- N
- Ccn
- 055798
- Associate id
- 3173432929
- Organization name
- GOLDEN OAK HOLDINGS, LLC
- Doing business as name
- VASONA CREEK HEALTHCARE CENTER
- Incorporation date
- 2003-01-27
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- VASONA CREEK HEALTHCARE CENTER
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 16412 LOS GATOS BLVD
- City
- LOS GATOS
- State
- CA
- Zip code
- 950325525