- Enrollment id
- O20160202002376
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1356746929
- Multiple npi flag
- N
- Ccn
- 055892
- Associate id
- 7113236266
- Organization name
- BERKELEY PINES SKILLED NURSING GROUP INC
- Doing business as name
- BERKELEY PINES SKILLED NURSING CENTER
- Incorporation date
- 2014-10-09
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- BERKELEY PINES SKILLED NURSING CENTER
- Address line 1
- 2223 ASHBY AVE
- City
- BERKELEY
- State
- CA
- Zip code
- 947051907