- Enrollment id
- O20240829004130
- Enrollment state
- OR
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1386483709
- Multiple npi flag
- N
- Ccn
- 385201
- Associate id
- 3375082621
- Organization name
- WILLOWBROOK SNF HEALTHCARE LLC
- Doing business as name
- WILLOWBROOK POST ACUTE
- Incorporation date
- 2024-05-10
- Incorporation state
- OR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- WILLOWBROOK POST ACUTE
- Affiliation entity name
- PACS GROUP
- Affiliation entity id
- 690
- Address line 1
- 707 SW 37TH ST
- City
- PENDLETON
- State
- OR
- Zip code
- 978013972