- Enrollment id
- O20180226002159
- Enrollment state
- CA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1366959876
- Multiple npi flag
- N
- Ccn
- 555781
- Associate id
- 8224399845
- Organization name
- VILLA DEL RIO, INC
- Doing business as name
- VILLA DEL RIO
- Incorporation date
- 2017-12-12
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 7002 GAGE AVE
- City
- BELL GARDENS
- State
- CA
- Zip code
- 902012014