- Enrollment id
- O20151030002057
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1295119212
- Multiple npi flag
- N
- Ccn
- 056334
- Associate id
- 5496065666
- Organization name
- CANTALOUPE HOLDINGS LLC
- Doing business as name
- BEACHWOOD POST-ACUTE & REHAB
- Incorporation date
- 2015-06-30
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BEACHWOOD POST-ACUTE & REHAB
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 1340 15TH ST
- City
- SANTA MONICA
- State
- CA
- Zip code
- 904041802