- Enrollment id
- O20230619000882
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1346942695
- Multiple npi flag
- N
- Ccn
- 555341
- Associate id
- 0547628836
- Organization name
- PEBBLE BEACH HOLDINGS LLC
- Doing business as name
- CANYON CREEK POST-ACUTE
- Incorporation date
- 2023-02-14
- Incorporation state
- CA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- CANYON CREEK POST-ACUTE
- Affiliation entity name
- LINKS HEALTHCARE GROUP
- Affiliation entity id
- 318
- Address line 1
- 22103 REDWOOD RD
- City
- CASTRO VALLEY
- State
- CA
- Zip code
- 945467107