- Enrollment id
- O20041207000776
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1336164151
- Multiple npi flag
- N
- Ccn
- 056311
- Associate id
- 9032175476
- Organization name
- CHA HOLLYWOOD MEDICAL CENTER LP
- Doing business as name
- HOLLYWOOD PRESBYTERIAN MEDICAL CENTER
- Incorporation state
- CA
- Organization type structure
- PARTNERSHIP
- Proprietary nonprofit
- P
- Nursing home provider name
- HOLLYWOOD PRESBYTERIAN MEDICAL CENTER D/P SNF
- Address line 1
- 4636 FOUNTAIN AVENUE
- City
- LOS ANGELES
- State
- CA
- Zip code
- 900291830