- Enrollment id
- O20200914001660
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1306476742
- Multiple npi flag
- N
- Ccn
- 055544
- Associate id
- 9830517432
- Organization name
- HARVARD CREEK POST ACUTE LLC
- Doing business as name
- HARVARD CREEK POST ACUTE
- Incorporation date
- 2019-02-13
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- HARVARD CREEK POST ACUTE
- Address line 1
- 519 W BADILLO ST
- City
- COVINA
- State
- CA
- Zip code
- 917223763