- Enrollment id
- O20090529000391
- Enrollment state
- WA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1316045537
- Multiple npi flag
- N
- Ccn
- 505239
- Associate id
- 4486703188
- Organization name
- BD TACOMA I, LLC
- Doing business as name
- PARK ROSE CARE CENTER
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PARK ROSE CARE CENTER
- Affiliation entity name
- REGENCY PACIFIC MANAGEMENT
- Affiliation entity id
- 442
- Address line 1
- 3919 S 19TH ST
- City
- TACOMA
- State
- WA
- Zip code
- 984051414