- Enrollment id
- O20061226000178
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1316005226
- Multiple npi flag
- N
- Ccn
- 555147
- Associate id
- 2961402847
- Organization name
- MAGNOLIA HOLDINGS, LLC
- Doing business as name
- OAK RIVER REHAB
- Incorporation date
- 2006-10-31
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- OAK RIVER REHAB
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 3300 FRANKLIN ST
- City
- ANDERSON
- State
- CA
- Zip code
- 960073279