- Enrollment id
- O20170925000698
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1306369871
- Multiple npi flag
- N
- Ccn
- 056065
- Associate id
- 4082988480
- Organization name
- SANTA CRUZIDENCE OPCO, LLC
- Doing business as name
- SANTA CRUZ POST ACUTE
- Incorporation date
- 2017-07-17
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SANTA CRUZ POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 1115 CAPITOLA RD
- City
- SANTA CRUZ
- State
- CA
- Zip code
- 950622844